Who is going to walk? A review of the factors inﬂuencing walking recovery after spinal cord injury

Frontiers in Human Neuroscience, 2014 · DOI: 10.3389/fnhum.2014.00141 · Published: March 13, 2014

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

Walking recovery is highly valued by patients and doctors, making it a key focus of new treatments and rehabilitation for SCI patients. Recent progress in understanding how the central nervous system regenerates offers potential for more neurological and functional improvements. Therefore, understanding the factors that influence walking recovery after SCI is crucial. This review examines factors that predict walking recovery, focusing on clinical aspects like neurological exams, age, cause of injury, gender, and recovery timeline. It also considers the role of instrumental examinations. The review suggests a reliable walking recovery prognosis is achievable. Instrumental examinations, particularly evoked potentials, can improve the accuracy of these predictions. This information is essential for healthcare planning, patient expectations, and clinical trial design to evaluate new treatments.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
Patients with complete sensory-motor lesions have very limited chances of regaining walking function, and if they do, they are often 'limited ambulators'.
2
AIS B patients with both light touch and pinprick preservation show better walking recovery compared to those with only light touch preservation.
3
Younger AIS C patients (under 50 years) have a significantly higher chance of achieving functional walking compared to older patients.

Research Summary

This review highlights that predicting walking recovery after SCI is possible based on patient demographics and clinical examination, particularly AIS classification. Instrumental examinations, like SSEPs and MEPs, enhance the ability to assess lesion severity and correlate with walking function, aiding in prognosis. Accurate prognosis is crucial for healthcare planning, addressing patient concerns, justifying rehabilitation services, and designing effective clinical trials for new therapies.

Practical Implications

Informed Patient Expectations

Provides realistic expectations for patients and their families regarding the likelihood of walking recovery, helping them cope with the challenges after SCI.

Optimized Rehabilitation Strategies

Allows clinicians to tailor rehabilitation programs based on prognostic factors, focusing on interventions most likely to improve walking function for specific patient subgroups.

Improved Clinical Trial Design

Offers prognostic data to design clinical trials effectively, distinguish between natural recovery and treatment effects, and determine the necessary sample sizes for statistical power.

Study Limitations

1
Small sample sizes in some studies.
2
Variations in the definition of walking function and follow-up time points across studies.
3
The majority of articles related to clinical factors date back to the 80s and 90s and might not fully reflect the current standards of care.

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