: Longitudinal recovery and reduced costs after 120 sessions of locomotor training for motor incomplete spinal cord injury
1Morrison S, 2Lorenz D, 3Eskay C, 4Forrest G, 5Basso D
1Shepherd Center, Inc, Atlanta, GA, USA; 2University of Louisville, Louisville, KY, USA; 3Wexner Medical Center, Outpatient Neurological Clinic, The Ohio State University,, Columbus, OH, USA; 4Kessler Foundation Research Center, Human Performance and Movement Analysis Laboratory, West Orange, NJ, USA; 5The Ohio State University, Columbus, OH, USA
Objective: To determine the impact of long term, body weight supported locomotor training (BWSLT) after chronic, incomplete spinal cord injury (SCI). Also, health care costs were estimated related to lost recovery potential and preventable secondary complications that may have occurred due to visit limits imposed by insurers.
Design/Methods: Prospective observational cohort with longitudinal follow up. Individuals with motor incomplete chronic SCI (Asia Impairment Scale C or D; n=69; 0.1-45 yr after SCI), who completed a minimum of 120 locomotor training sessions were included. The intervention included manually-assisted locomotor training in a body weight supported treadmill environment, overground standing and stepping activities, and community integration tasks. Longitudinal outcome measure collection occurred every 20 treatments and at 6-12 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 6-12 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.
Support: This article was previously supported by Cooperative Agreement numbers 1U59DD000838, 1U59DD000338, and U10/CCU220379 from the Centers for Disease Control and Prevention (CDC).
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