Spinal Cord Injury Clinical Trial
Official title:
Body Weight Supported Ambulation Training After Spinal Cord Injury
Body weight support (BWS) treadmill training uses an overhead harness to give partial support to patients walking on a treadmill. This study will determine whether BWS training is more effective than conventional rehabilitation therapy in improving walking ability in patients with spinal cord injuries (SCI).
Gait rehabilitation is a specific component of physical rehabilitation of persons with
sub-acute or chronic spinal cord injury (SCI). One novel method of gait rehabilitation
involves the use of an overhead support point and a harness. The BWS strategy has been
combined with treadmill-based gait training in recent studies with dramatic results. It is
believed that this form of training may enhance output of a ‘central pattern generator' of
stepping movement from circuitry intrinsic to the patient's spinal cord. However, only
limited attention has been paid to the role that training-induced physical conditioning
might play in mediating functional improvements.
This study will evaluate whether BWS gait training is more effective than conventional
rehabilitation therapy in improving functional gait in patients with neurologically
incomplete spinal cord injury. The study will also compare treadmill-based training to
overground-based training. Treadmill-based training has the inherent advantage of providing
highly rhythmic input to the subject's legs; overground-based training has the inherent
advantage of allowing use of assistive devices and thereby replicating a more ‘natural'
training condition.
Patients with chronic SCI (greater than 1 year post-injury) and patients with sub-acute SCI
(2 to 8 months post-injury) will be evaluated. Patients with chronic SCI will be randomly
assigned to one of 3 groups: body weight support and treadmill-based training, body weight
support and overground training, and conventional rehabilitation therapy. Patients with
sub-acute injury will be randomized to receive either BWS treadmill training or conventional
rehabilitation. Training sessions are typically 1 hour long, with 3 sessions per week for 13
weeks.
All patients will be evaluated with a battery of functional, metabolic, and neurophysiologic
measures prior to the onset of training and during the week after training has been
completed. The primary outcome measure will be average maximum overground walking velocity
without body weight support but with the use of passive assistive devices. Secondary
measures will concentrate on function (balance, mobility), fitness (work capacity, strength,
gait efficiency), and spinal cord neurophysiology (motor conduction, reflex excitability).
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Single Blind, Primary Purpose: Treatment
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