OBJECTIVE: To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation. METHODS: A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score < 4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI. RESULTS: No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 +/- 0.6 m/s, n = 30) and CONT (1.1 +/- 0.7, n = 25) groups. CONCLUSIONS: The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.
RCT Entities:
OBJECTIVE: To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation. METHODS: A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score < 4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI. RESULTS: No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 +/- 0.6 m/s, n = 30) and CONT (1.1 +/- 0.7, n = 25) groups. CONCLUSIONS: The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.
Authors: Bruce H Dobkin; David Apple; Hugues Barbeau; Michele Basso; Andrea Behrman; Dan Deforge; John Ditunno; Gary Dudley; Robert Elashoff; Lisa Fugate; Susan Harkema; Michael Saulino; Michael Scott Journal: Neurorehabil Neural Repair Date: 2003-09 Impact factor: 3.919
Authors: Carolee J Winstein; J Philip Miller; Sarah Blanton; Edward Taub; Gitendra Uswatte; David Morris; Deborah Nichols; Steven Wolf Journal: Neurorehabil Neural Repair Date: 2003-09 Impact factor: 3.919
Authors: B Dobkin; H Barbeau; D Deforge; J Ditunno; R Elashoff; D Apple; M Basso; A Behrman; S Harkema; M Saulino; M Scott Journal: Neurorehabil Neural Repair Date: 2007 Jan-Feb Impact factor: 3.919
Authors: Andresa R Marinho; Heather M Flett; Catharine Craven; C Andrea Ottensmeyer; Daria Parsons; Molly C Verrier Journal: J Spinal Cord Med Date: 2012-09 Impact factor: 1.985
Authors: Carey L Holleran; Patrick W Hennessey; Abigail L Leddy; Gordhan B Mahtani; Gabrielle Brazg; Brian D Schmit; T George Hornby Journal: J Neurol Phys Ther Date: 2018-04 Impact factor: 3.649