Interventions to reduce spasticity and improve function in people with chronic incomplete spinal cord injury: distinctions revealed by different analytical methods

Neurorehabil Neural Repair, 2015 · DOI: 10.1177/1545968314558601 · Published: July 1, 2015

Simple Explanation

This study looks at ways to help people with spinal cord injuries walk better. Spinal cord injuries can make muscles tight, which makes walking difficult. The researchers tried two things: a special machine called Lokomat that helps people move their legs, and a medicine called Tizanidine that relaxes muscles. The researchers used different ways to measure if the treatments worked. One way was to see if people improved a little bit (MID), and another was to see if they could be sorted into groups based on how well they improved (GMM). The results showed that both treatments helped some people walk better, but the medicine seemed to help people who were already walking pretty well, and the Lokomat helped people of different walking abilities.

Study Duration

4 weeks

Participants

83 participants with incomplete SCI

Evidence Level

Not specified

Key Findings

1
Improvements in function were achieved in a limited number of people with SCI.
2
Both MID and GMM-RCR analyses revealed that tizanidine improved endurance in high functioning participants.
3
GMM-RCR classification also showed that speed and mobility improved after locomotor training.

Research Summary

This study investigated the effects of pharmacological and physical (locomotor training) interventions on function in people living with incomplete motor function loss due to SCI, and used different analytical techniques to understand whether functional levels affect recovery with different interventions. Mixed model ANOVAs revealed small improvements in walking speed and endurance with interventions in people with chronic SCI; however similar results were observed between interventions. Both MID and GMM-RCR analysis revealed improvements in walking endurance with Tizanidine in high function participants only; a finding that typical group averaging technique could not detect.

Practical Implications

Personalized Treatment

Baseline walking speed can help predict the likelihood of improvement with Tizanidine or LTT, allowing for more personalized treatment plans.

Outcome Measure Selection

The TUG test may be more suitable for assessing mobility improvements in lower-functioning individuals, while 10MWT and 6MWT are better for higher-functioning individuals.

Analytical Technique Choice

GMM and MID analyses can reveal differences in treatment effects between high and low functioning participants that may be missed by traditional group averaging techniques (ANOVA).

Study Limitations

1
Significant improvements found by RCR were small, and considerably less than our MID values, thus the changes due to the interventions may still not be clinically relevant
2
Only a relatively small number of subjects (2-6 participants per group) achieved the MID, and this was also the case in the control group
3
The participants in this study were also not followed up; therefore we cannot speculate on whether noted changes were long-standing in these patients.

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