Locomotor Training in the Pediatric Spinal Cord Injury Population: A Systematic Review of the Literature

Top Spinal Cord Inj Rehabil, 2016 · DOI: 10.1310/sci2202-135 · Published: January 1, 2016

Spinal Cord Injury Pediatrics Rehabilitation

Simple Explanation

Locomotor training (LT) is an activity-based rehabilitation strategy that aims to restore both walking and postural control after SCI. The goal of activity-based therapies is to focus on recovery and minimize compensatory strategies such as the use of assistive devices, as these strategies may interfere with neuroplasticity and neural recovery. Several different types of LT exist, including body weight supported treadmill training (BWSTT) and robotic LT. These devices are utilized with the goal of providing appropriate afferent information for the desired motor pattern by decreasing the postural requirements and level of physical assistance needed.

Study Duration

Not specified

Participants

7 participants, ranging in age from 4.5 to 17 years

Evidence Level

Case studies, implementing pre- and posttest outcome measurements

Key Findings

1
The combined results of the 6 studies suggest that the pediatric SCI population can benefit from receiving LT.
2
As indicated by gait speed, distance, walking independence, and participation, the evidence shows that participants made gains in their ability to ambulate, regardless of change in ISNCSCI classification.
3
Results indicated that 4 of the 7 participants were suffering from an acute SCI at the time LT began, whereas 3 participants did not begin LT until after their injury was chronic.

Research Summary

This systematic review aimed to evaluate the effects of locomotor training (LT) on pediatric spinal cord injury (SCI) patients and to develop recommendations for pediatric LT guidelines. Six case studies were analyzed, revealing gains in distance, gait speed, walking independence, and participation among the participants. The review concludes that currently, there is insufficient evidence to determine the best clinical practice guidelines for rehabilitation using LT within the pediatric SCI population, highlighting the need for further research.

Practical Implications

Need for Standardized Protocols

The lack of standardized LT interventions within the pediatric SCI population necessitates the development of specific guidelines to optimize treatment effectiveness.

Early Intervention Considerations

While improvements were noted in both acute and chronic SCI patients, further investigation is needed to determine the optimal timing for initiating LT in the pediatric population.

Outcome Measure Refinement

The variability and potential unreliability of current outcome measures in the pediatric SCI population call for the development and validation of more specific and reliable assessment tools.

Study Limitations

1
There were only 6 studies deemed appropriate for this review, all of which were case studies and none had a control variable.
2
Of the 6 studies, only 1 followed a standardized protocol, indicating the lack of standardized LT interventions within the pediatric SCI population.
3
The small, specific, patient population impacts the external validity and generalization of research findings.

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