Article

Impaired walking limits function after spinal cord injury (SCI), but
training-related improvements are possible even in people with chronic motor
incomplete SCI. The objective of this study was to compare changes in
walking speed and distance associated with 4 locomotor training approaches.
DESIGN: This study was a single-blind, randomized clinical trial. SETTING: This study was conducted in a rehabilitation research laboratory. PARTICIPANTS:
Participants were people with minimal walking function due to chronic SCI.
INTERVENTION: Participants (n=74) trained 5 days per week for 12 weeks with the
following approaches: treadmill-based training with manual assistance (TM),
treadmill-based training with stimulation (TS), overground training with
stimulation (OG), and treadmill-based training with robotic assistance (LR).
MEASUREMENTS: Overground walking speed and distance were the primary outcome
measures. RESULTS: In participants who completed the training (n=64), there were
overall effects for speed (effect size index [d]=0.33) and distance (d=0.35). For
speed, there were no significant between-group differences; however, distance
gains were greatest with OG. Effect sizes for speed and distance were largest
with OG (d=0.43 and d=0.40, respectively). Effect sizes for speed were the same
for TM and TS (d=0.28); there was no effect for LR. The effect size for distance
was greater with TS (d=0.16) than with TM or LR, for which there was no effect.
Ten participants who improved with training were retested at least 6 months after
training; walking speed at this time was slower than that at the conclusion of
training but remained faster than before training. LIMITATIONS: It is unknown
whether the training dosage and the emphasis on training speed were optimal.
Robotic training that requires active participation would likely yield different
results. CONCLUSIONS: In people with chronic motor incomplete SCI, walking speed
improved with both overground training and treadmill-based training; however,
walking distance improved to a greater extent with overground training.

Langue : ANGLAIS