Category: Spinal Cord Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : Demonstrate gait improvements for patients with chronic incomplete tetraplegia participating in intensive Activity-Based Restorative Therapy (ABRT)
Design : Case Series
Setting : Hospital-Based Outpatient Rehabilitation Center
Participants (or Animals, Specimens, Cadavers) : Subject 1: 24 yo male, C4 AIS C traumatic SCI at age 18, non-ambulatory one year post injury. Subject 2: 23 yo male, C4 AIS D non-traumatic SCI at age 13, ambulating short distances one year post injury. At initial presentation, subjects had limited lower extremity strength, required physical assistance with transfers, and used power mobility in the home.
Interventions : Subjects participated in two-week intensive ABRT programs every 4-12 months over 6-7 years. Interventions included functional electrical stimulation (FES), locomotor training, aquatic therapy, therapeutic exercise/activity, robotic gait training. Subjects also completed home-based programs including FES cycling, balance activities, and walking. A retrospective chart review was completed to gather data.
Main Outcome Measure(s) : 10-meter walk test (10MWT), 6-Minute Walk Test (6MWT), WISCI II, Berg Balance Scale
Results : Subject 1 improved WISCI II (3 to 13), 6MWT (48 to 192 feet), 10MWT (68 to 40 seconds), and Berg (4 to 33). Subject 2 improved WISCI II (6 to 16), 6MWT (183 to 705 feet), 10MWT (45 to 15 seconds), and Berg (8 to 31). Both now transfer and ambulate independently within their homes.
Conclusions : These cases suggest that consistent, durable, and functionally significant gait improvement is possible in patients with chronic incomplete tetraplegia who participate in activity-based rehabilitation. Further, the time course suggests that patients with chronic SCI do not plateau and have the capacity for long term progress with consistent intervention, including a rigorous home program. Study into the effects of ABRT on neurologic recovery, timing of functional changes, and durability of the results in chronic SCI is warranted.