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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- Gait quality is improved by locomotor training in individuals with SCI regardless of training approach.J Neuroeng Rehabil. 2009; 6: 36
- Effects of locomotor training after incomplete spinal cord injury: a systematic review.Arch Phys Med Rehabil. 2013; 94: 2297-2308
- Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI.Neurology. 2006; 66: 484-493
- Should body weight–supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate?.Neurorehabil Neural Repair. 2012; 26: 308-317
- Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial.Phys Ther. 2011; 91: 48-60
- Overground locomotor training in spinal cord injury: a performance-based framework.Top Spinal Cord Inj Rehabil. 2017; 23: 226-233
- Dynamic stability requirements during gait and standing exergames on the Wii fit® system in the elderly.J Neuroengineering Rehabil. 2012; 9: 28
- Postural control during gait initiation and termination of adults with incomplete spinal cord injury.Hum Mov Sci. 2015; 41: 20-31
- Effects of overground locomotor training on walking performance in chronic cervical motor incomplete spinal cord injury: a pilot study.Arch Phys Med Rehabil. 2017; 98: 1119-1125
- Fatigability, oxygen uptake kinetics and muscle deoxygenation in incomplete spinal cord injury during treadmill walking.Eur J Appl Physiol. 2017; 117: 1989-2000
- Effects of overground locomotor training on the ventilatory response to volitional treadmill walking in individuals with incomplete spinal cord injury: a pilot study.Spinal Cord Ser Cases. 2017; 3: 17011
- Constraints on the development of coordination.in: Wade M.G. Whiting H.T. Motor development in children: aspects of coordination and control. Martinus Nijhoff Publishers, Dordrecht, the Netherlands1986
- Movement systems as dynamical systems.Sports Med. 2003; 33: 245-260
- Metabolic energy expenditure and the regulation of movement economy.Psychon Bull Rev. 1998; 5: 173-196
- Academy of Neurologic Physical Therapy. Professional resources.(Available at: http://www.neuropt.org/professional-resources/neurology-section-outcome-measures-recommendations/spinal-cord-injury)Date accessed: January 15, 2019
- Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.Neurorehabil Neural Repair. 2007; 21: 539-550
- The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI).J Rehabil Med. 2001; 33: 177-181
- Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation.Arch Phys Med Rehabil. 2012; 93: 1508-1517
- Effectiveness of automated locomotor training in patients with acute incomplete spinal cord injury: a randomized, controlled, multicenter trial.J Neurotrauma. 2017; 34: 1891-1896
- Advancing the evidence base of rehabilitation treatments: a developmental approach.Arch Phys Med Rehabil. 2012; 93: S101-S110
- Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial.Arch Phys Med Rehabil. 2014; 95: 2239-2246
- Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale.Spinal Cord. 2010; 48: 245-250
- Analysis and comparison of the psychometric properties of three balance measures for stroke patients.Stroke. 2002; 33: 1022-1027
Published online: April 23, 2019
Supported in part by the George Mason University Provost Multidisciplinary Research Initiative award.
© 2019 by the American Congress of Rehabilitation Medicine