Retraining Walking After Spinal Cord Injury

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Brief Title

Retraining Walking After Spinal Cord Injury

Official Title

Activity-Dependent Plasticity After Spinal Cord Injury

Brief Summary

      Incomplete spinal cord injury often results in difficulty walking. Training on a treadmill
      with body weight support may improve walking ability after spinal cord injury. The purpose of
      this study is to examine the effect of treadmill speed on spinal cord function and walking
      performance.
    

Detailed Description

      Conventional rehabilitation following spinal cord injury (SCI) emphasizes functional gains
      through strengthening and compensation, using braces and assistive devices to achieve
      mobility. Rehabilitation practice using compensatory approaches is based on the prevailing
      assumption that neural recovery is not possible following SCI.

      Recent evidence contradicts this assumption. Stimulated by the proper activation of
      peripheral afferents associated with walking, neuronal circuits may reorganize by
      strengthening of existing and previously inactive descending connections and local neural
      circuits. New approaches to locomotor recovery after SCI utilize sensory information related
      to locomotion to improve treadmill and overground walking.

      Locomotor training velocity may be a critical, task-specific, and activity-dependent
      parameter affording appropriate phasic, afferent input to the neural system and promoting
      neural plasticity. The purpose of this study is to evaluate the effects of training velocity
      in a long-term locomotor training program on both neurophysiological and behavioral
      plasticity in individuals with incomplete SCI.

      Sixteen patients with incomplete SCI will be recruited to participate in this study. Baseline
      evaluations will include American Spinal Injury Association classification, rate-sensitive
      depression, phase-dependent H-reflex modulation at self-selected and fast overground walking
      velocities, and MRI of the spine. Patients will wear a step activity monitor for a 48-hour
      period, quantifying baseline walking activity level.

      All patients will participate in a locomotor training program. Patients will be randomly
      assigned to either training at self-selected treadmill velocity or at a normal walking
      velocity. Patients will have 45 training sessions over 9 weeks. Each training session will
      include 30 minutes of walking. Interim testing of rated depression, spatial-temporal
      parameters of walking, MRI, and walking activity will occur through the 9-week training
      period. Post-testing will occur within 2 days of the last training session and at a 1 month
      after completion of the training. During the month following long-term training, patients
      will be instructed to return to their self-selected routine activities of daily living.
    

Study Phase

Phase 2/Phase 3

Study Type

Interventional




Condition

Spinal Cord Injuries

Intervention

Locomotor treadmill training with body weight support


Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Behavioral

Estimated Enrollment

16

Start Date

May 2000

Completion Date

January 2005


Eligibility Criteria

        Inclusion criteria:

          -  First time spinal cord injury (SCI) from trauma, vascular, or orthopedic pathology at
             cervical or thoracic levels

          -  Category C or D SCI as defined by the American Spinal Injury Association (ASIA)
             Impairment Scale

          -  1 to 3 years post-SCI

          -  Ability to walk independently a minimum of 40 feet with or without an assistive device

          -  Currently spending a minimum of 30 minutes per day walking

          -  No change in anti-spasticity medication during the study

          -  Medically stable

          -  Participant's personal physician must verify the participant's medical status

        Exclusion criteria:

          -  Bladder infection, decubiti, osteoporosis, cardiopulmonary disease, pain, or other
             significant medical complications that would prohibit or interfere with training and
             testing of walking function or alter compliance with a training protocol

          -  Currently participating in a rehabilitation program or another research protocol that
             could interfere or influence the outcome measures of the current study

          -  Congenital SCI (e.g., Chiari malformation, myelomeningocele, intraspinal neoplasm,
             Frederich's ataxia)

          -  Other degenerative spinal disorders (e.g., spinocerebellar degeneration,
             syringomyelia) that may complicate the treatment or evaluation procedures
      

Gender

All

Ages

6 Years - 65 Years

Accepts Healthy Volunteers

No

Contacts

Andrea L Behrman, PhD, , 

Location Countries

United States

Location Countries

United States

Administrative Informations


NCT ID

NCT00059553

Organization ID

K01HD001348



Study Sponsor

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborators

 US Department of Veterans Affairs

Study Sponsor

Andrea L Behrman, PhD, Principal Investigator, University of Florida


Verification Date

August 2005