Effects of body weight-support treadmill training on postural sway and gait independence in patients with chronic spinal cord injury

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1389676 · Published: January 1, 2019

Simple Explanation

This study investigated whether a six-week body weight-support treadmill training (BWSTT) program could improve balance and walking ability in people with incomplete spinal cord injuries (iSCI). The researchers measured center-of-mass control and gait independence before and after the BWSTT program. The study used an instrumented sway test to measure balance and the Walking Index Spinal Cord Injury (WISCI) II test to assess walking ability. They compared the results of iSCI patients to those of healthy individuals. The study found that BWSTT improved center-of-mass control in iSCI patients, but did not lead to improvements in gait independence. This suggests that while BWSTT can help with balance, it may not be enough to improve walking ability in chronic iSCI patients.

Study Duration

6 Weeks

Participants

17 chronic iSCI patients and 17 healthy subjects

Evidence Level

Descriptive

Key Findings

1
The normalized JERK (NJ) of chronic iSCI patients significantly decreased after completion of the BWSTT protocol, indicating improved center-of-mass control.
2
No significant pre- vs. post-BWSTT differences in RMS values were recorded, suggesting that the amount of postural sway was not significantly affected.
3
Postural control improvements in the standing balance of iSCI patients, measured by the NJ, had no impact on gait independence as measured by the WISCI II scale.

Research Summary

This study assessed the impact of a six-week BWSTT program on center-of-mass (COM) control in chronic iSCI patients using an ISway test. The program improved COM control, as measured by normalized JERK (NJ). While the BWSTT program improved standing balance, there were no improvements in gait independence. This suggests that improving static postural control does not necessarily translate to improved walking ability in this population. An inverse correlation was found between initial JERK values and WISCI II scores, indicating that individuals with worse postural control had poorer gait independence. However, this correlation did not hold after the BWSTT intervention.

Practical Implications

Rehabilitation Strategies

BWSTT can be a useful tool for improving balance and postural control in iSCI patients, but it may need to be combined with other therapies to improve gait independence.

Assessment of Postural Control

The ISway test with inertial sensors provides a sensitive and reliable method for assessing postural control in iSCI patients and could be used to monitor progress during rehabilitation.

Timing of Intervention

The limited impact on gait independence may be due to the chronic stage of the injury in the participants, suggesting that earlier intervention may be more effective for improving walking ability.

Study Limitations

1
The study included a relatively small sample size (n=17) of iSCI patients.
2
The participants were all in the chronic stage of injury (>12 months post-injury), which may limit the generalizability of the findings to acute iSCI patients.
3
Five of the iSCI patients achieved a maximum WISCI II score before beginning the BWSTT program, potentially limiting the ability to detect improvements in gait independence.

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