Walking Adaptability Post-Spinal Cord Injury

University of Florida

Status: Completed

Conditions: Brown Sequard Syndrome; Incomplete Spinal Cord Injury

Treatments: Behavioral: Locomotor Training; Other: Cross-Sectional Testing (No Intervention)

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT01851629

01-2013

W81XWH-11-1-0454 (Other Grant/Funding Number)

Details and patient eligibility

About

The purpose of this study is: (1) to establish assessment techniques (in our laboratory) to identify the functional integrity of long spinal tracts associated with adaptive walking recovery post-spinal cord injury and (2) to preliminary investigate locomotor outcomes associated with an adaptive locomotor training approach post-spinal cord injury.

Full description

Eligible individuals without spinal cord injury that are enrolled in the study will participate for 1-2 days. These individuals may undergo a variety of non-invasive neurophysiological tests which evaluate spinal reflexes and integrity of specific spinal pathways. In addition, their movement may be assessed during walking on a treadmill and overground in a variety of different conditions (e.g. with mirrors, without mirrors, with obstacles, without obstacles).

Eligible individuals with spinal cord injury that are enrolled in the study will undergo the same testing as described above for the healthy controls. In addition, a small subset of these individuals may receive locomotor training (3 weeks of basic locomotor training followed by 3 weeks of adaptive locomotor training, separated by a 3 week washout period). For the individuals receiving locomotor training, they will be tested before and after each 3 week training session.

Enrollment: 7 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18 years or older
• no neurologic injury (for individuals without SCI)
• >12 mos post-incomplete SCI (iSCI), discharged from in- and out-patient rehabilitation, with diagnosis of first time motor iSCI (AIS C or D with upper motor neuron lesions at cervical or thoracic levels) (for individuals with SCI)
• medically stable condition with no changes in anti-spasticity meds
• ability to walk in the home and/or ambulate in the community using a single cane or crutch, bilateral canes or crutches, or no device
• walking speeds > 0.3 m/sec, with deficit performance on the Dynamic Gait Index
• medically approved for participation

Exclusion criteria

• current participation in another rehabilitation program/research protocol
• history of congenital SCI or other degenerative spinal disorders
• inappropriate or unsafe fit of the harness and/or joint contractures or severe spasticity that would prohibit the safe provision of training
• receipt of a therapeutic intervention or medication within the last 6 mos that would alter the nervous system's ability to respond to treatment (e.g. Botox injections)
• unable to safely receive transcranial magnetic stimulation due to positive history which prohibits its use

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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7 participants in 3 patient groups

ADAPT Locomotor Training

Experimental group

Description:

Individuals receive 15 sessions of ADAPT-locomotor training for 3 weeks. During ADAPT-locomotor training, stepping in response to obstacles and walking challenges are practiced on a treadmill and overground.

Treatment:

Behavioral: Locomotor Training

Basic Locomotor Training

Active Comparator group

Description:

Individuals will receive 15sessions of the traditional form of basic locomotor training for 3 weeks. Repetitive stepping patterns are practiced on the treadmill and overground.

Treatment:

Behavioral: Locomotor Training

Cross-Sectional Testing

Other group

Description:

Individuals with and without spinal cord injury will be evaluated to develop protocols within our laboratory to assess reflexes (spinal tract integrity), walking ability, and whether mirror images during walking enhance or disrupt motor responses during walking.

Treatment:

Other: Cross-Sectional Testing (No Intervention)