The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: the multicenter randomized Spinal Cord Injury Locomotor Trial.
BACKGROUND
The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation.


METHODS
This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks.


RESULTS
No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L >or= 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of >or= 0.6 m/s correlated with a LEMS near 40 or higher.


CONCLUSIONS
Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C.
Dobkin
B
B
Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA. bdobkin@mednet.ucla.edu
Barbeau
H
H
Deforge
D
D
Ditunno
J
J
Elashoff
R
R
Apple
D
D
Basso
M
M
Behrman
A
A
Harkema
S
S
Saulino
M
M
Scott
M
M
D000328:Adult; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D020127:Recovery of Function / Q000502:physiology; D016037:Single-Blind Method; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*