Two Different Therapies Show Promise for Some With Partial Spinal Cord Injury
Spinal Cord Injury
Body weight-supported treadmill training isn't more effective than conventional mobility rehabilitation for restoring movement to those with partial spinal cord injury, according to a new study. But an unexpectedly high number of patients achieved functional walking speeds regardless of treatment type. The study is published in the Feb. 28 issue of Neurology, the scientific journal of the American Academy of Neurology.
The multicenter trial analyzed 117 individuals who had a partial spinal cord injury within the previous eight weeks. Through random selection, 58 patients received body weight-supported treadmill training and 59 patients received conventional overground mobility therapy. Based on level of impairment, they were also categorized into three groups, B (more impaired), C or D (less impaired). All patients received an equal amount of therapy for 12 weeks. The difference in therapy strategies is the conventional group didn't use a treadmill or body-weight support.
"We initially expected that body weight-supported treadmill training would be more effective to regain walking ability than the conventional overground mobility therapy, particularly in groups B and C," said study author Dr. Bruce H. Dobkin, professor of neurology and medical director of the Neurologic Rehabilitation and Research Program at the David Geffen School of Medicine at UCLA. "But what we found was no significant difference in strategies among individuals in groups C and D, who achieved walking abilities beyond expectations."
The vast majority of individuals in group C became able to walk independently by six months following their injury, regardless of the therapy strategy (24 out of 26 treated with weight-supported treadmill therapy and 24 out of 26 treated with conventional overground mobility therapy). There was no statistical difference between therapy strategies in walking speed achieved at six months follow-up for those in groups C and D who were able to walk. Their average speed was 1.1 meters per second.
Entering the trial earlier (less than four weeks after the injury) was associated with faster walking speeds and longer walking distances at the six-month follow-up.
"Although these results give an unexpected answer to the initial question, the study is important and ultimately successful, because it reaffirms the importance of controlled experiments, highlights major gaps in current knowledge, and will help guide the design, implementation, and assessment of new treatment methods in spinal cord injury," said Dr. Jonathan R. Wolpaw, a member of the American Academy of Neurology who wrote an editorial in the same issue of Neurology.
Given that both therapy methods produced similar outcomes, clinicians and patients could base their use of each strategy on personal preferences, skill, availability of equipment and costs, Dobkin said.
The study received funding support by grants from the National Institutes of Health and from the Foundation for Spinal Cord Research in Quebec.