Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury

TLDR

Persons with motor complete spinal cord injury, which entails no voluntary movement or sphincter function below the injury level but some retained sensation, do not recover independent walking. The study aimed to determine whether intense locomotor treadmill training with weight support and simultaneous spinal cord epidural stimulation could restore walking in patients with chronic motor complete spinal cord injury. The intervention combined treadmill training, weight support, and epidural stimulation over 278 sessions for one patient and 81 sessions for another, spanning 85 and 15 weeks respectively. Two patients achieved over‑ground walking and all four attained independent standing and trunk stability, though one patient sustained a hip fracture during training. Funding was provided by the Leona M.

Abstract

Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent walking. We tested intense locomotor treadmill training with weight support and simultaneous spinal cord epidural stimulation in four patients 2.5 to 3.3 years after traumatic spinal injury and after failure to improve with locomotor training alone. Two patients, one with damage to the mid-cervical region and one with damage to the high-thoracic region, achieved over-ground walking (not on a treadmill) after 278 sessions of epidural stimulation and gait training over a period of 85 weeks and 81 sessions over a period of 15 weeks, respectively, and all four achieved independent standing and trunk stability. One patient had a hip fracture during training. (Funded by the Leona M. and Harry B. Helmsley Charitable Trust and others; ClinicalTrials.gov number, NCT02339233 . ).