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Thread: The evolution of walking-related outcomes over the first 12 weeks of rehabilitation

  1. #1

    The evolution of walking-related outcomes over the first 12 weeks of rehabilitation

    Neurorehabil Neural Repair. 2007 Jan-Feb;21(1):25-35.

    The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: the multicenter randomized Spinal Cord Injury Locomotor Trial.

    Dobkin B, Barbeau H, Deforge D, Ditunno J, Elashoff R, Apple D, Basso M, Behrman A, Harkema S, Saulino M, Scott M; Spinal Cord Injury Locomotor Trial Group.

    Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA.

    BACKGROUND: The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation. METHODS: This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks. RESULTS: No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L >or= 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of >or= 0.6 m/s correlated with a LEMS near 40 or higher. CONCLUSIONS: Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C.

    I have not finsished reading the article but I already have several comments to make. I will post later.

    “As the cast of villains in SCI is vast and collaborative, so too must be the chorus of hero's that rise to meet them” Ramer et al 2005

  2. #2
    Senior Member
    Join Date
    Sep 2006
    hampton bays new york
    I totaly agree,,,,If I hadn't bitched and fought the first few months they never would have let me TRY, One Big lie, "the standing frame [parrell bars] are broken. Wouldn't you know the first sloppy trip I did with the walker, there they were, in fine shape, and a 350lb, "don't want to do it" patiant was using them. I was furious, my response "f#$k you". I was hardly ever any more livid in my life. talk about a kick in the ass. At that point I was most willing and ready, to try, not some months later. My father was especialy hit hard by the "new" I gave him the next day he visited.
    Last edited by alhavel; 06-15-2007 at 02:51 PM.

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