Original research| Volume 100, ISSUE 10, P1888-1893, October 2019

Effects of Performance-Based Training on Gait and Balance in Individuals With Incomplete Spinal Cord Injury

Published:April 23, 2019DOI:



      To determine changes in balance and gait following a task-specific, performance-based training protocol for overground locomotor training (OLT) in individuals with motor-incomplete spinal cord injury (iSCI).


      Convenience sample, prepilot and postpilot study.


      Human performance research laboratory.


      Adults (N=15; 12 men and 3 women; mean age [y] ± SD, 41.5±16.9), American Spinal Injury Association Impairment Scale C or D, >6 months post-spinal cord injury.


      Two 90-minute OLT sessions per week over 12 to 15 weeks. OLT sessions were built on 3 principles of motor learning: practice variability, task specificity, and progressive overload (movement complexity, resistance, velocity, volume). Training used only voluntary movements without body-weight support, robotics, electrical stimulation, or bracing. Subjects used ambulatory assistive devices as necessary.

      Main Outcome Measures

      Berg Balance Scale (BBS), Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) gait parameters, spatiotemporal measures of gait (step length, step width, percent stance, stance:swing ratio) from 7 participants who walked across a pressure-sensitive walkway.


      Fourteen participants completed the OLT protocol and 1 participant completed 15 sessions due to scheduled surgery. The BBS scores showed a mean improvement of 4.53±4.09 (P<.001). SCI-FAI scores showed a mean increase of 2.47±3.44 (P=.01). Spatiotemporal measures of gait showed no significant changes.


      This pilot demonstrated improvements in balance and selected gait characteristics using a task-specific, performance-based OLT for chronic iSCI.


      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), BBS (Berg Balance Scale), iSCI (incomplete spinal cord injury), OLT (overground locomotor training), SCI-FAI (Spinal Cord Injury Functional Ambulation Inventory)
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