title: Longitudinal patterns of functional recovery in patients with incomplete spinal cord injury receiving activity-based rehabilitation.
abstract: OBJECTIVE
  To model the progression of 3 functional outcome measures from patients with incomplete spinal cord injury (SCI) receiving standardized locomotor training.
  
  
  METHODS
  Observational cohort.
  
  
  METHODS
  The NeuroRecovery Network (NRN), a specialized network of treatment centers providing standardized, activity-based therapy for SCI patients.
  
  
  METHODS
  Patients (N=337) with incomplete SCI (grade C or D on the International Standards for Neurological Classification of Spinal Cord Injury scale) who were enrolled in the NRN between February 2008 and March 2011.
  
  
  METHODS
  All enrolled patients received standardized locomotor training sessions, as established by NRN protocol, and were evaluated monthly for progress.
  
  
  METHODS
  Berg Balance Scale, 6-minute walk test, and 10-meter walk test. Progression over time was analyzed via the fitting of linear mixed effects models.
  
  
  RESULTS
  There was significant improvement on each outcome measure and significant attenuation of improvement over time. Patients varied significantly across groups defined by recovery status and American Spinal Injury Association Impairment Scale (AIS) grade at enrollment with respect to baseline performance and rates of change over time. Time since SCI was a significant determinant of the rate of recovery for all measures.
  
  
  CONCLUSIONS
  Locomotor training, as implemented in the NRN, results in significant improvement in functional outcome measures as treatment sessions accumulate. Variability in patterns of recovery over time suggest that time since SCI and patient functional status at enrollment, as measured by the Neuromuscular Recovery Scale, are important predictors of performance and recovery as measured by the targeted outcome measures.
authors.affiliation: Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lorenz
authors.forename: Somnath
authors.initials: S
authors.lastname: Datta
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Harkema
mesh_terms: D000328:Adult; D000367:Age Factors; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010045:Outpatients; D004856:Postural Balance; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000534:rehabilitation*; D013997:Time Factors; D015599:Trauma Severity Indices; D016138:Walking