Sarah A Morrison1, Douglas Lorenz2, Carol P Eskay3, Gail F Forrest4, D Michele Basso5. 1. Shepherd Center, Atlanta, GA. Electronic address: Sarah_morrison@shepherd.org. 2. Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, Louisville, KY. 3. Wexner Medical Center, Outpatient Neurological Clinic, The Ohio State University, Columbus, OH. 4. Human Performance and Movement Analysis Laboratory, Kessler Foundation Research Center, West Orange, NJ. 5. School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH.
Abstract
OBJECTIVE: To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. DESIGN: Prospective observational cohort with longitudinal follow-up. SETTING: Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). PARTICIPANTS: Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions. INTERVENTIONS: Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks. MAIN OUTCOME MEASURES: International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. RESULTS: Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. CONCLUSIONS: Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs.
OBJECTIVE: To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. DESIGN: Prospective observational cohort with longitudinal follow-up. SETTING: Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). PARTICIPANTS: Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions. INTERVENTIONS: Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks. MAIN OUTCOME MEASURES: International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. RESULTS: Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. CONCLUSIONS: Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs.
Authors: Dezhi Lu; Yang Yang; Pingping Zhang; Zhenjiang Ma; Wentao Li; Yan Song; Haiyang Feng; Wenqiang Yu; Fuchao Ren; Tao Li; Hong Zeng; Jinwu Wang Journal: Tissue Eng Regen Med Date: 2022-06-29 Impact factor: 4.169
Authors: Troy Q Tabarestani; Nicholle E Lewis; Margot Kelly-Hedrick; Nina Zhang; Brianna R Cellini; Eric J Marrotte; Theresa Williamson; Haichen Wang; Daniel T Laskowitz; Timothy D Faw; Muhammad M Abd-El-Barr Journal: Neurospine Date: 2022-09-30
Authors: Nicholle E Lewis; Troy Q Tabarestani; Brianna R Cellini; Nina Zhang; Eric J Marrotte; Haichen Wang; Daniel T Laskowitz; Muhammad M Abd-El-Barr; Timothy D Faw Journal: Neurospine Date: 2022-09-30
Authors: Katie L Gant; James D Guest; Anne E Palermo; Aditya Vedantam; George Jimsheleishvili; Mary Bartlett Bunge; Adriana E Brooks; Kim D Anderson; Christine K Thomas; Andrea J Santamaria; Monica A Perez; Rosie Curiel; Mark S Nash; Efrat Saraf-Lavi; Damien D Pearse; Eva Widerström-Noga; Aisha Khan; W Dalton Dietrich; Allan D Levi Journal: J Neurotrauma Date: 2021-05-03 Impact factor: 4.869