TRANSLATING RESEARCH IN NEUROTRAUMA: WEIGHT-SUPPORT REHABILITATION TRIALS FOR SCI

HARKEMA , SUSAN

University of Louisville, Frazier Rehab Institute, Department of Neurological Surgery, Louisville , KY , United States .

Locomotor training (LT) using body weight support on a treadmill (BWST) with manual assistance has been reported to improve functional outcomes in individuals after spinal cord injury (SCI).  The first single-blinded, multicenter randomized trial entered 146 research participants from 6 regional centers within 8 weeks of SCI graded as American Spinal Injury Association (ASIA) B, C or D from C-5 to L-3 scoring  < 4 on the Functional Independence Measure for locomotion (FIM-L).  Research participants were randomized to either the experimental group that received LT using BWST and overground practice or the control (CONT) group that received a defined mobility training requiring 30 – 60 minutes of weight bearing each session.  Both groups received 45 – 60 sessions of their mobility training in 12 weeks in addition to standard rehabilitation therapies for mobility and self-care skills.   Speeds for UMN ASIA C and D individuals were not significantly different between BWSTT (1.1 ± 0.6 m/s, n=30) and CONT (1.1 ± 0.7 m/s, n=25) groups.  Ninety two percent of these individuals regained walking ability and the speeds were significantly faster than expected.   These unexpected outcomes may have been in part attributable to limiting entry to subjects who did not have serious co-morbidities and also represented relatively young population.  The CONT and LT groups received similar amounts of weight bearing and number of sessions, however, the intensity of therapy in both treatment groups may have been greater than the rehabilitation usually provided.  It is also possible that the natural history of disability after incomplete spinal cord injury may be different from what is currently assumed.  The highly functional outcomes in most of the ASIA C and D subjects regardless of the intervention suggest that when some threshold of supraspinal input and segmental sensory feedback are available, intense, repetitive task-specific can result in highly functional gains.