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Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury

AL Behrman, PT, PhD, is Associate Professor, Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Fla, and Research Investigator, VA Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Fla.
AR Lawless-Dixon, PT, DPT, is Staff Physical Therapist, Shands at the University of Florida Medical Center, Gainesville, Fla
SB Davis, PT, is Research Physical Therapist, VA Brain Rehabilitation Research Center, Malcom Randall VA Medical Center
MG Bowden, MS, PT, is Research Physical Therapist, VA Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, and doctoral student, Rehabilitation Science Doctoral Program, University of Florida
P Nair, BPhT, is doctoral candidate, Rehabilitation Science Doctoral Program, University of Florida
C Phadke, PT, is doctoral candidate, Rehabilitation Science Doctoral Program, University of Florida
EM Hannold, PhD, is Research Health Scientist, Veterans Affairs Health Sciences Research and Development Service and VA Rehabilitation Research and Development Service, Rehabilitation Outcomes Research Center, Gainesville, Fla
P Plummer, PT, PhD, is NIDRR Postdoctoral Fellow, Brooks Center for Rehabilitation Studies, University of Florida, Jacksonville, Fla
SJ Harkema, PhD, is Associate Professor and Rehabilitation Research Director, Owsley B. Frazier Chair in Spinal Cord Rehabilitation, Department of Neurological Surgery, University of Louisville, and Frazier Rehab Institute, Louisville, Ky

Address all correspondence to Dr Behrman at Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Box 100154, UFHSC, Gainesville, FL 32610-0154 (USA) (abehrman{at}phhp.ufl.edu)

Background and Purpose. The use of locomotor training with a body-weight–support system and treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report is to describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Case Description. Following discharge from rehabilitation, a man with an incomplete SCI at C5–6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45 sessions of locomotor training. Outcomes. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for community mobility. Walking activity (±SD) per 24 hours increased from 1,054±543 steps to 3,924±1,629 steps. Discussion. In a person with an incomplete SCI, walking ability improved after locomotor training that used a decision-making algorithm and progression across training environments.

Key Words: Gait • Locomotor training • Recovery • Spinal cord injury

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