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The Evolution of Walking-Related Outcomes Over the First 12 Weeks of Rehabilitation for Incomplete Traumatic Spinal Cord Injury: The Multicenter Randomized Spinal Cord Injury Locomotor Trial

Department of Neurology, University of California Los Angeles, Los Angeles, CA, bdobkin{at}mednet.ucla.edu

H. Barbeau, PhD

McGill University/Institut de Readaptation de Montreal, Montreal, Canada

D. Deforge, MD

University of Ottawa Rehabilitation Hospital, Ottawa, Canada

J. Ditunno, MD

Magee Rehabilitation Center/Jefferson University, Philadelphia, PA

R. Elashoff, PhD

Department of Biomathematics, University of California Los Angeles, Los Angeles, CA

D. Apple, MD

Shepherd Rehabilitation Center, Atlanta, GA

M. Basso, EdD

Department of Rehabilitation Medicine, Ohio State Univeristy, Columbus, OH

A. Behrman, PhD

University of Florida, Department of Physical Therapy, Gainesville, FL

L. Fugate

S. Harkema, PhD

Department of Neurosurgery, University of Louisville, Louisville, Kentucky

M. Saulino, MD

Magee Rehabilitation Center/Jefferson University, Philadelphia, PA

M. Scott, MD

Rancho Los Amigos National Rehabilitation Center, Downey, CA

the Spinal Cord Injury Locomotor Trial Group

Background. The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation.

Methods. This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks.

Results. No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of 0.6 m/s correlated with a LEMS near 40 or higher.

Conclusions. Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C.

Key Words: Spinal cord injury • Rehabilitation • Walking outcomes • Treadmill training • Locomotion

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