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Retraining Walking Adaptability Following Incomplete Spinal Cord Injury


Retraining Walking Adaptability Following Incomplete Spinal Cord Injury

Emily J Fox et al. Spinal Cord Ser Cases.


Introduction: Functional walking requires the ability to modify one's gait pattern to environmental demands and task goals-gait adaptability. Following incomplete spinal cord injury (ISCI), gait rehabilitation such as locomotor training (Basic-LT) emphasizes intense, repetitive stepping practice. Rehabilitation approaches focusing on practice of gait adaptability tasks have not been established for individuals with ISCIs but may promote recovery of higher level walking skills. The primary purpose of this case series was to describe and determine the feasibility of administering a gait adaptability retraining approach-Adapt-LT-by comparing the dose and intensity of Adapt-LT to Basic-LT.

Case presentation: Three individuals with ISCIs (>1 year, AIS C or D) completed three weeks each (15 sessions) of Basic-LT and Adapt-LT. Interventions included practice on a treadmill with body weight support and practice overground (≥30 mins total). Adapt-LT focused on speed changes, obstacle negotiation, and backward walking. Training parameters (step counts, speeds, perceived exertion) were compared and outcomes assessed pre and post interventions. Based on completion of the protocol and similarities in training parameters in the two interventions, it was feasible to administer Adapt-LT with a similar dosage and intensity as Basic-LT. Additionally, the participants demonstrated gains in walking function and balance following each training type.

Discussion: Rehabilitation that includes stepping practice with adaptability tasks is feasible for individuals with ISCIs. Further investigation is needed to determine the efficacy of Adapt-LT.

Conflict of interest statement

Compliance with ethical standardsThe authors declare that they have no competing interests.The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, Department of VA, or the U.S. Government.


Fig. 1
Fig. 1
Case series design and training parameters. LT locomotor training, Basic-LT basic locomotor training, Adapt-LT Adapt locomotor training
Fig. 2
Fig. 2
Treadmill and Overground Adapt-locomotor training. a Participant SCI01 performing obstacle negotiation on treadmill. b Participant SCI02 performing backward walking on treadmill. c Participant SCI03 performing obstacle negotiation overground. d Participant SCI02 performing backward walking overground. TM treadmill, OG overground
Fig. 3
Fig. 3
Training parameters for the three participants (SCI01-SCI03) during Basic- and Adapt-locomotor training. a Average number of steps during training on the treadmill. b Average number of steps during training overground. c Average Borg Ratings of Perceived Exertion during training. d Maximum training speeds. BLT Basic locomotor training, ALT Adapt locomotor training

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