Use of water- and land-based gait training to improve walking capacity in adults with complete spinal cord injury: A pilot study

The Journal of Spinal Cord Medicine, 2024 · DOI: 10.1080/10790268.2022.2088507 · Published: June 29, 2022

Simple Explanation

This study investigates whether underwater treadmill training (UTT) combined with overground walk training (OWT) can improve walking ability in individuals with complete spinal cord injury (cSCI). Participants with cSCI underwent a year-long program of UTT and supplemental OWT, and their walking capacity was assessed using the Walking Index for Spinal Cord Injury (WISCI-II). The results showed a significant improvement in walking capacity, suggesting that this combined approach can enhance mobility in individuals with cSCI, even without epidural spinal cord stimulation (eSCS).

Study Duration

1 Year

Participants

5 adults with motor-complete (AIS A), chronic cSCI

Evidence Level

Not specified

Key Findings

1
A significant time effect (P < .05) for WISCI-II was observed, indicating improvement in walking capacity over the study period.
2
WISCI-II level documented at T3 (8.40 ± 1.34) was significantly higher compared to the T1 value (0.20 ± 0.45).
3
All study participants registered a marked improvement in WISCI-II level over the 12-month training program (mean change = 8.2; range = 6–9).

Research Summary

This pilot study examined the impact of underwater treadmill training (UTT) and overground walk training (OWT) on walking capacity in adults with complete spinal cord injury (cSCI). Five participants underwent a year-long program, and their walking ability was assessed using the Walking Index for Spinal Cord Injury (WISCI-II) at three time points. The study found a significant improvement in walking capacity following the combined UTT and OWT intervention, suggesting potential benefits for individuals with cSCI.

Practical Implications

Therapeutic Applications

The findings suggest potential therapeutic applications for combined UTT and OWT in improving locomotor function in persons with cSCI who have not undergone eSCS.

Accessibility of Training

The study highlights the possibility of using smaller, portable underwater treadmills to extend the accessibility of UTT beyond research settings.

Personal Goal Achievement

The improvement in WISCI-II levels following UTT and supplemental OWT is consistent with the progression in assisted and unassisted overground walking and the realization of self-selected goals.

Study Limitations

1
The absence of a control group limits the extent to which gains in walking capacity can be solely attributable to UTT and supplemental OWT.
2
The small sample size of our patient group limits the ability to discern trends linking time-related changes in WISCI-II levels.
3
Access to primary-source evaluations would have reduced bias resulting from potential classification errors.

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