Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury

Frontiers in Human Neuroscience, 2022 · DOI: 10.3389/fnhum.2022.849297 · Published: May 11, 2022

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study looks at how a short period of exercise focusing on motor skills affects walking and balance in people with incomplete spinal cord injuries. The researchers also tested whether using a brain stimulation technique called transcranial direct current stimulation (tDCS) could enhance the benefits of the exercise. The study found that the exercise program improved walking and balance, but the addition of tDCS did not provide any extra benefit.

Study Duration

5 days

Participants

26 adults with chronic motor-incomplete spinal cord injury

Evidence Level

Level 1, Double-blind randomized controlled pilot study

Key Findings

1
Brief intensive motor skill training (MST) involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes.
2
Concurrent application of tDCS did not further enhance the effects of MST on walking and balance.
3
Between-day (offline) effects contributed to a greater percentage of total change in outcomes compared to within-day (online) effects for walking speed, cadence, and stride length.

Research Summary

This study examined the effects of a 3-day moderate-intensity MST program on measures of walking and balance function in participants with MISCI. Participation in brief MST was associated with significant increases in overground walking speed, cadence, bilateral stride length, stronger limb TLA, and weaker limb ACC. Measures of balance function and perceived fear of falling were also improved. Concurrent application of tDCS failed to produce greater improvements in walking and balance function compared to MST plus sham tDCS.

Practical Implications

Rehabilitation Strategy

Brief, intensive motor skill training can improve walking and balance outcomes for individuals with motor-incomplete spinal cord injury. This could be implemented in home or community settings.

tDCS Effectiveness

Concurrent tDCS may not provide additional benefits to motor skill training for improving walking and balance in this population. Further research is needed to optimize tDCS protocols.

Offline Motor Learning

The study highlights the importance of offline motor learning processes in rehabilitation, suggesting that interventions should consider strategies that promote consolidation of motor skills between training sessions.

Study Limitations

1
The recruitment goal of 30 participants was not reached (n = 25) and between-groups sample sizes were unbalanced
2
Mean baseline walking speed and total LEMS differed between groups
3
The absence of a non-MST control group complicates interpretation of the unique contributions of the MST intervention

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