title: Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation.
abstract: OBJECTIVE
  To evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).
  
  
  METHODS
  Patients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN.
  
  
  METHODS
  Intensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration.
  
  
  METHODS
  Berg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test.
  
  
  RESULTS
  Outcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement.
  
  
  CONCLUSIONS
  Significant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI.
authors.affiliation: Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY, USA. susan.harkema@jhsmh.org
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Harkema
authors.forename: Mary
authors.initials: M
authors.lastname: Schmidt-Read
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lorenz
authors.forename: V Reggie
authors.initials: VR
authors.lastname: Edgerton
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Behrman
mesh_terms: D000328:Adult; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D004856:Postural Balance; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013997:Time Factors; D015599:Trauma Severity Indices; D016138:Walking