Article

Retraining walking following spinal cord injury using visually guided
tasks may be especially efficacious because it engages the motor cortex, whose
input may facilitate improvements in functional walking. OBJECTIVES: To contrast
2 methods of retraining, one emphasizing precise, visually guided walking over
obstacles and on targets (Precision Training),
the other emphasizing mass
practice of walking on a treadmill (Endurance Training). METHODS: A randomized,
single-blind, crossover design was used. Twenty-two participants, >/=7 months
postinjury, were randomly allocated to start with Precision or Endurance
Training. Each phase of training was 5 times per week for 2 months, followed by a
2-month rest. MEASURES: of walking speed, distance, skill, confidence, and
depression were obtained before training, then monthly thereafter. RESULTS: Both
forms of training led to significant improvements in walking, with Endurance
Training inducing bigger improvements in walking distance than Precision
Training, especially for high-functioning walkers who had initial walking speeds
>0.5 m/s. The largest improvements in walking speed and distance occurred in the
first month of Endurance Training, with minimal changes in the second month of
training. In contrast, improvements in walking skill occurred over both months
during both types of training. Retention of over ground walking speed, distance,
and skill was excellent for both types of training.
CONCLUSIONS: Intensive
walking training in the chronic phase after spinal cord injury is effective in
improving over ground walking. Visually guided tasks for training individuals
with chronic spinal cord injury were not superior to mass practice on a treadmill.

Langue : ANGLAIS