A research protocol to study the critical time window for rehabilitation after incomplete spinal cord injury: early vs. late locomotor training

BMC Neurology, 2024 · DOI: https://doi.org/10.1186/s12883-024-03980-x · Published: November 13, 2024

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

This study aims to find the best time to start intense walking training after a spinal cord injury to improve recovery. The study will look at people who start training very soon after their injury compared to those who start later. Participants will be divided into groups that begin training at different times: early (less than 60 days post-injury), 3 months, or 6 months after injury. A control group will receive standard care. The researchers will track how well people can walk and how active they are in their daily lives for a year after the injury to see if starting training at a specific time leads to better results.

Study Duration

12 months

Participants

108 participants with acute, traumatic SCI

Evidence Level

Level 1, Randomized, multi-site clinical trial

Key Findings

1
The study hypothesizes that early intervention (less than 60 days post-SCI) will yield the greatest improvements in walking ability and community ambulation.
2
The primary outcomes measured will be gait speed (10 m Walk Test) and walking endurance (6-Minute Walk Test).
3
Secondary outcomes include daily step count via wearable sensors, lower extremity strength, and quality of life measures.

Research Summary

This study is designed to investigate the optimal timing of rehabilitation interventions following acute traumatic spinal cord injury (SCI). The primary objective is to identify a potential time window of adaptive neuroplasticity after SCI by comparing the effectiveness of high-intensity gait training initiated at different time intervals post-injury. The trial will assess long-term effects of training administered at different times by monitoring participants for up to one year post-injury and analyzing metrics such as daily step count and overall mobility.

Practical Implications

Optimized Rehabilitation Protocols

Identifying a period of heightened plasticity could help optimization of rehabilitation protocols and reinforce early mobilization, potentially leading to more personalized and effective therapeutic strategies.

Healthcare System Efficiency

Understanding the impact of training timing could enhance long-term outcomes for individuals with SCI and prioritize increased efficiency of care within the broader healthcare system.

Enhanced Quality of Life

Optimizing the timing of rehabilitation interventions based on neuroplasticity may enhance the quality of life for individuals with SCI.

Study Limitations

1
The primary risk is potential for falls during locomotor training or outcomes testing
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Another risk during this study is significant fatigue during the training session
3
An individual undergoing BWSTT is at risk for the development of other injuries including pressure sores, orthopedic pain, and delayed onset muscle soreness.

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