| Institution: | 1. International Center for Spinal Cord Injury, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD;2. Johns Hopkins School of Medicine, Baltimore, MD;3. American Family Children''s Hospital, University of Wisconsin, Madison, WI;4. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD;5. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore MD;1. Reeve Irvone Research Center, University of California-Irvine, Orange, CA;2. Neurorehabilitation Laboratory, University of California-Irvine, Orange, CA;3. Department of Neurology, University of California-Irvine, Orange, CA;4. Center for Biostatistics, The Ohio State University Medical Center, Columbus, OH;5. School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH;1. Dept. of Rehabilitation Medicine, Emory University, Atlanta, GA, USA;2. Dept. of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA;1. Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan;2. School of Rehabilitation, Université de Montréal, 7077 Avenue du Parc, Montréal, Quebec H3C 3J7, Canada;3. Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of the Institut de réadaptation Gingras-Lindsay-de-Montréal, 6300 Avenue du Darlington, Montréal, Quebec H3S 2J4, Canada;4. Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada;5. Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada |
| Abstract: | ObjectiveTo examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation.DesignRandomized controlled trial with delayed treatment design.SettingOutpatient program in a private, nonprofit rehabilitation hospital.ParticipantsVolunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI).InterventionsA 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.Main Outcome MeasuresNeurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check).ResultsSignificant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score 5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score 4.2±5.2 vs ?0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002).ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits. |
