Supported treadmill ambulation training after spinal cord injury: A pilot study

Objectives: To conduct a pilot study of weight-supported ambulation trainin g after incomplete spinal cord injury (SCI), and to assess its safety. Design: Quasiexperimental, repeated measures, single group. Setting: Veterans Affairs medical center. Patients: Three subjects with incomplete, chronic, thoracic SCIs; 2 classif ied as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. Intervention: Subjects participated in 12 weeks of training assisted by 2 p hysical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started a t 40% of body weight and a treadmill speed of .16kmph, and progressed by re ducing support and increasing treadmill speed and continuous treadmill walk ing time up to 20 minutes. Training was conducted for 1 hour per day, 5 day s per week for 3 months. Treadmill walking occurred for 20 minutes during t he sessions. Main Outcome Measures: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor c ontrol assessment; self-report indices; ASIA classification; muscle functio n test; and safety. Results: All 3 subjects increased gait speed (.118m/s initially to .318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5mi n). The oxygen costs decreased from 1.96 to 1.33mL . kg(-1) . m(-1) after 1 2 weeks of training. Conclusions: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using obj ective gait measures. The self-report indices used have promise as patient- centered outcome measures of this new form of gait training. A larger, cont rolled study of this technique is warranted.