Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Trials

Background:

• Incomplete spinal cord injury (SCI) presents significant challenges to mobility and functional independence.
• Rehabilitation strategies aim to maximize recovery and improve walking ability in SCI patients.
• Comparing different therapeutic approaches is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the efficacy of body weight support on a treadmill (BWSTT) with over-ground practice against conventional over-ground mobility therapy (CONT).
• To evaluate functional outcomes in patients with incomplete SCI undergoing inpatient rehabilitation.

Main Methods:

• A multicenter, single-blinded, randomized clinical trial (MRCT) involving 146 subjects with incomplete SCI (ASIA B, C, D; C5-L3 levels; FIM-L score < 4).
• Participants received 12 weeks of either BWSTT or CONT.
• Primary outcomes assessed at 6 months post-SCI included Functional Independence Measure for locomotion (FIM-L) and walking speed.

Main Results:

• No significant differences were observed between BWSTT and CONT groups in FIM-L scores or walking speed/distance at 6 months.
• A high percentage of upper motor neuron (UMN) subjects achieved independent walking: 35% of ASIA B, 92% of ASIA C, and 100% of ASIA D.
• Walking velocities were comparable between BWSTT and CONT for ASIA C and D UMN subjects.

Conclusions:

• BWSTT and conventional over-ground mobility therapy demonstrate similar efficacy in improving walking function for incomplete SCI patients.
• The high rate of functional walking in ASIA C subjects, regardless of treatment, highlights the potential for recovery in this population.
• This study underscores the value of MRCTs in evaluating rehabilitation strategies and provides insights into disability after incomplete SCI.