Abstract
Objectives: A pilot study was conducted on five patients with an incomplete spinal cord injury (iSCI) using a body weight support treadmill training (BWSTT) gait strat egy within the subacute phase of recovery. The objectives of this project were to de fine appropriate candidates, identify treatment parameters, select impairment and dis ability outcome measures, and solicit consumer input in preparation for a clinical efficacy trial.
Methods: Five patients with injuries ranging from C2 lesion to T10 lesion con sented to participate and were within 2 months post injury. A commercially available mechanical suspension frame straddled a motorized treadmill, and a modified climber's harness was used for support. All participants were nonambulatory on entry into the study. The BWSTT intervention, consisting of 36 1-hour sessions over a 3-month period, was conducted by physical therapists and was customized to the patient's abil ities. Evaluations were conducted at baseline, at 6 weeks, and at the 12-week post- test interval. Clinical impairment measures included muscle strength, sensation, mus cle tone, perceived exertion, and treadmill training endurance. Gait analysis provided dynamic quantification of kinematic and surface electromyography (EMG) of five mus cles of the right lower limb on all participants on the BWS treadmill and three of the five patients during overground walking. A disability outcome measure was used to grade the level of ambulation function. A consumer team member conducted feed back interviews with participants to obtain their input to this research direction.
Results: Lower limb unloading varied from 26 percent to 83 percent of body weight. All participants completed the 12-week training program and four individu als eventually progressed to overground walking. The fifth participant, who had the most severe motor impairments, did not achieve functional overground walking with out the aid of bilateral knee-ankle-foot orthoses. Improvements were evident in the clinical measures of strength, endurance, and percent BWS in four patients. Positive changes were recorded in temporal-spatial, joint motion, and EMG gait measures matching increased ambulation function in four of the five patients. Gait analysis
changes in one patient were highlighted to illustrate dynamic measures of motor re covery. Consumer input and feedback from patients and therapists were positive and included suggestions for improvements.
Conclusions: A multicenter randomized controlled trial is advocated to evaluate the efficacy of a BWSTT gait strategy in the subacute recovery phase of iSCI. This pilot work resulted in specific recommendations in the selection of candidates, the training and evaluation parameters, and the potential value of consumer input for fu ture research.