Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI

Neurology, 2006 · DOI: 10.1212/01.wnl.0000202600.72018.39 · Published: February 28, 2006

Simple Explanation

This study compares two methods of physical therapy for people with incomplete spinal cord injuries: body weight supported treadmill training (BWSTT) and over-ground mobility training. The goal was to see if one method was better at helping patients regain their ability to walk after being admitted for inpatient rehabilitation. The results showed that both methods led to similar improvements in walking ability, suggesting that neither approach was superior in this patient population.

Study Duration

12 weeks intervention, 6 months follow up

Participants

146 subjects with incomplete SCI (ASIA B, C, or D)

Evidence Level

Level I, Randomized Clinical Trial

Key Findings

1
No significant differences were found between BWSTT and over-ground training (CONT) groups in terms of FIM-L scores or walking speed at 6 months after SCI.
2
A high percentage of ASIA C subjects achieved functional walking speeds, irrespective of the treatment they received.
3
Earlier entry into the trial (<4 weeks after SCI) was associated with faster walking speeds and longer walking distances at 6 months.

Research Summary

This multicenter, randomized clinical trial compared body weight-supported treadmill training (BWSTT) to conventional over-ground mobility training (CONT) in patients with incomplete spinal cord injury (SCI). The study found no significant differences in outcomes between the two groups, suggesting that both approaches are equally effective for improving walking ability after incomplete SCI. The unexpectedly high percentage of ASIA C subjects who achieved functional walking speeds, regardless of treatment, highlights the potential for recovery in this population.

Practical Implications

Treatment Choice

Clinicians and patients can choose between BWSTT and over-ground training based on personal preferences, available equipment, skill, and costs, as both strategies yield similar outcomes.

Early Intervention

Emphasizes the importance of early intervention (within 4 weeks of SCI) to maximize walking outcomes.

Potential for ASIA C Patients

Rehabilitation programs should expect a high percentage of ASIA C patients to achieve functional walking speeds with either BWSTT or over-ground training.

Study Limitations

1
The study fell short in recruiting ASIA D UMN and LMN subjects.
2
The study did not recruit a sufficient number of LMN subjects to complete independent analyses for those with conus/cauda equina SCI.
3
The contrast in the amount of standing and stepping between the two groups, however, was probably less than anticipated.

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