Standardized Locomotor Training Across Eight Clinical Sites: Outcomes from the Reeve Foundation NeuroRecovery Network 2005-2016
1Tefertiller C, 2Behrman A, 3Schmidt Read M, 3Watson E, 4Forrest G, 5Basso M, 6Morrison S, 2Atkinson K, 7Taylor H, 8Ugilweneza B, 8Lorenz D, 9Harkema S
1Craig Hospital, Englewood, CO, USA; 2Frazier Rehabilitation Institute, Louisville, KY, USA; 3Magee Rehabilitation, Philadelphia, PA, USA; 4Kessler Foundation, West Orange, NJ, USA; 5Ohio State University, Columbus, OH, USA; 6Shepherd Center, Atlanta, GA, USA; 7TIRR, Houston, TX, USA; 8Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science, School of Public Health and Information Sciences, Louisville, KY, USA; 9Kentucky Spinal Cord Injury Research Center, Frazier Rehabilitation Institute, Louisville, KY, USA
Background: Locomotor training (LT) — the repetition of stepping-like patterning to promote walking recovery in either a body-weight supported (BWS) or a non- BWS condition — has been a focus of activity-based therapy (ABT) research to date. Literature supports that participation in intensive LT programs for individuals with SCI may result in improved walking function including but not limited to speed, endurance, balance and independence. However, much of this literature has reported on very small sample sizes.
Design/Method: A retrospective analysis was completed on individuals with SCI who were enrolled in the Christopher and Dana Reeve NeuroRecovery Network (NRN) from 2005-2016. As a part of an outpatient therapy program, these individuals completed standardized LT sessions which consisted of 55 minutes of treadmill training with BWS followed immediately by 30 minutes of over ground/community mobility training that focused on improving overall functional mobility and independence as directed by their performance on the Neuromuscular Recovery Scale (NRS). Standardized outcome assessments were completed every 20 sessions during the individual’s outpatient therapy program to include the following: International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI), Neuromuscular Recovery Scale (NRS) phasing to quantify stages of functional recovery without compensation, 6 minute walk test (6MWT), 10 meter walk test (10MWT), Berg Balance Scale (BBS) and Modified Functional Reach (MFR).
Results: Five hundred twenty-nine individuals were enrolled at 8 NRN sites between March 2005 and September 2016. Seventy-eight percent were male with the majority sustaining cervical SCIs (66%) classified as ASIA impairment scale (AIS) D (53%). Median LT intensity was 3 days/week (range 1-5 days/week). The median time since injury was 0.9 years (0.1-53.1) and individuals completed an average of 43 LT sessions (interquartile range: 20-80). From enrollment to final evaluation, individuals demonstrated statistically significant improvements (p<0.001) in the following outcomes: 6MWT (median 116-237m); 10MWT (median 0.38m/s-0.82m/s); BBS (median 6-13) and MRF (median 12-16). Improvements were also noted in upper extremity motor scores (median 38-42), lower extremity motor scores (median 27-32) as well as the NRS. Participants who completed 3-5 sessions/week demonstrated the largest improvements in all outcomes of interest. As participants progressed with the LT program, 3-5 LT sessions/week continued to be associated with a positive improvement.
Conclusion: A large cohort of individuals with SCI who participated in a standardized intensive LT protocol demonstrated improvements in functional mobility, neuromuscular recovery, motor function, and balance. Improvements were most significant in those who completed a greater number of sessions/week illustrating that intensity of training may be a key factor in facilitating recovery after SCI.
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