Training of Walking Skills Overground and on the Treadmill: Case Series on Individuals With Incomplete Spinal Cord Injury

• Published in: Physical therapy Vol. 89; no. 6; pp. 601 - 611
• Main Authors: Musselman, Kristin E, Fouad, Karim, Misiaszek, John E, Yang, Jaynie F
• Format: Journal Article
• Language: English
• Published: United States American Physical Therapy Association 01-06-2009; Oxford University Press
• Subjects: Activities of Daily Living; Adult; Care and treatment; Data analysis; Data collection; Disability Evaluation; Exercise equipment; Exercise Therapy - methods; Female; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - rehabilitation; Health aspects; Humans; Male; Medical research; Middle Aged; Outcome Assessment (Health Care); Patients; Physical therapists; Physical therapy; Physical Therapy Modalities; Physiological aspects; Practice; Recovery of Function; Skills; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation; Studies; Walking; Weight-Bearing - physiology; Canada
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20080257

Walking in the home and community is an important goal for individuals with incomplete spinal cord injury (iSCI). Walking in the community requires various skills, such as negotiating curbs, doors, and uneven terrain. This case report describes the use of a method to retrain walking overground that is intensive, variable, and relevant to daily walking (skill training). The aims of this case series were to determine the effectiveness of skill training in a small group of people with iSCI and to compare skill training with body-weight-supported treadmill training (BWSTT) in the same individuals.
Four individuals who were a median of 2.7 years (interquartile range [IQR]=12.8) after iSCI participated in alternating phases of intervention, each 3 months long. All patients started with BWSTT. Two patients subsequently engaged in skill training while the other 2 patients engaged in BWSTT, after which a third phase of intervention (opposite to the second) was repeated.
The Modified Emory Functional Ambulation Profile, the 10-Meter Walk Test, the 6-Minute Walk Test, the Berg Balance Scale, and the Activities-specific Balance Confidence Scale were administered before training, monthly throughout training, and 3 months after training.
Overall improvements in walking speed met or exceeded the minimal clinically important difference for individuals with iSCI (> or = 0.05 m/s), particularly during the skill training phase (skill training: median=0.09 m/s, IQR=0.13; BWSTT: median=0.01 m/s, IQR=0.07). Walking endurance, obstacle clearance, and stair climbing also improved with both types of intervention. Three of the 4 patients had retained their gains at follow-up (retention of walking speed: median=92%, IQR=63%). Thus, the findings suggest that skill training was effective in this small group of individuals.