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February 28, 2006; 66 (4) Articles

Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI

B. Dobkin, D. Apple, H. Barbeau, M. Basso, A. Behrman, D. Deforge, J. Ditunno, G. Dudley, R. Elashoff, L. Fugate, S. Harkema, M. Saulino, M. Scott, the Spinal Cord Injury Locomotor Trial (SCILT) Group
First published February 27, 2006, DOI: https://doi.org/10.1212/01.wnl.0000202600.72018.39
B. Dobkin
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D. Apple
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H. Barbeau
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M. Basso
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D. Deforge
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J. Ditunno
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M. Saulino
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M. Scott
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Citation
Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI
B. Dobkin, D. Apple, H. Barbeau, M. Basso, A. Behrman, D. Deforge, J. Ditunno, G. Dudley, R. Elashoff, L. Fugate, S. Harkema, M. Saulino, M. Scott, the Spinal Cord Injury Locomotor Trial (SCILT) Group
Neurology Feb 2006, 66 (4) 484-493; DOI: 10.1212/01.wnl.0000202600.72018.39

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Abstract

Objective: To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.

Methods: A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score <4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.

Results: No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 ± 0.6 m/s, n = 30) and CONT (1.1 ± 0.7, n = 25) groups.

Conclusions: The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.

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Letters: Rapid online correspondence

    • Hugues Barbeau, McGill University, Montreal, Quebec, Canada H3G 1Y5hugues.barbeau@mcgill.ca
    Submitted November 03, 2006
  • Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI
    • Anton Wernig, Phyiology Univ. Bonn and Klinikum Karlsbad-Langensteinbach, Wilhelmstrasse 31, 53111 Bonn, Germanyanton.wernig@ukb.uni-bonn.de
    Submitted June 07, 2006
  • Reply from the Author
    • Bruce H. Dobkin, MD, Department of Neurology, University of California Los Angeles, UCLA School of Medicine, RNRC, 710 Westwood Plaza, Los Angeles, CA 90095bdobkin@mednet.ucla.edu
    Submitted June 07, 2006
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