Locomotor Training After Human Spinal Cord Injury: A Series of Case Studies

TLDR

Many individuals with spinal cord injury do not regain walking, but mammals can relearn stepping with sensory input, suggesting that similar training might promote locomotor recovery in humans. The study aimed to use locomotor training that provides sensory information associated with locomotion to improve stepping and walking in adults after spinal cord injury. Four adults, with a mean of six months postinjury, received this locomotor training on a treadmill. All subjects improved treadmill stepping, one achieved overground walking and two improved overground walking, indicating that locomotor training may enhance walking recovery after spinal cord injury.

Abstract

Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. Mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as ASIA A, subject 2 had a T5 injury classified as ASIA C, subject 3 had a C6 injury classified as ASIA D, and subject 4 had a T9 injury classified as ASIA D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.