title: Activity-based therapy for recovery of walking in chronic spinal cord injury: results from a secondary analysis to determine responsiveness to therapy.
abstract: OBJECTIVE
  To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial.
  
  
  METHODS
  Secondary analysis of results from a randomized controlled trial with delayed treatment design.
  
  
  METHODS
  Outpatient program in a private, nonprofit rehabilitation hospital.
  
  
  METHODS
  Volunteer sample of adults (N=38; 27 men; 11 women; age, 22-63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI).
  
  
  METHODS
  A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.
  
  
  METHODS
  Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test).
  
  
  RESULTS
  This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program.
  
  
  CONCLUSIONS
  ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA. Electronic address: mike_jones@shepherd.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Jones
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Evans
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Candace
authors.initials: C
authors.lastname: Tefertiller
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Backus
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sweatman
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Keith
authors.initials: K
authors.lastname: Tansey
authors.affiliation: Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Morrison
mesh_terms: D000328:Adult; D002908:Chronic Disease; D026241:Exercise Movement Techniques; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D018579:Patient Selection; D020127:Recovery of Function; D055070:Resistance Training; D013119:Spinal Cord Injuries / Q000145:classification / Q000503:physiopathology / Q000534:rehabilitation*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*; D055815:Young Adult
keywords: Exercise therapy; Gait disorders, neurologic; Motor activity; Rehabilitation; Spinal cord injuries