Walking-Related Outcomes for Individuals with Motor Incomplete Spinal Cord Injuries (SCIs) : 12 weeks of Step Ergometry Training in Combination with Electrical Stimulation (ES).

Research Report
Population: Adult

Candy R Tefertiller, DPT, NCS, Director of Physical Therapy, Craig Hospital ctefertiller@craighospital.org

Don Gerber, PsyD ANPP, Pincipal Investigator, Craig Hospital dgerber@craighospital.org

Keywords: Plasticity, Walking, Electrical Stimulation, Step Ergometry

Purpose: The purpose of this study was to evaluate the effects of step ergometry training in combination with ES and over ground training on walking function in individuals with chronic motor incomplete SCIs.

Participants: A convenience sample of 14 individuals with motor incomplete SCIs was obtained from a specialty center in SCI rehabilitation. All participants had chronic (>1 year) motor incomplete SCIs and were either non-ambulatory or ambulating < .8m/s at the start of their participation in the study.

Materials/Methods: Participants completed training 3x/week for 12 weeks. Twelve channels of ES were applied to each individual to achieve a maximally tolerated motor contraction for the following muscle groups: quadriceps, hamstrings, gluteals, plantarflexors, dorsiflexors and trunk extensors. Participants progressed from 15 to 45 minutes of a combination of step ergometry and ES over 2 weeks with the addition of over ground gait training in week 3. Body weight support was utilized for the step ergometry and was adjusted to achieve optimal upright extension during training. Neurological sensory-motor status, walking and metabolic function were evaluated pre training and immediately post training with the following: ISNCSCI, 10MWT 6minWT, TUG, and WISCI II.

Results: Ten of 14 participants completed the training protocol. Four individuals dropped out of the study due to fatigue, time commitment, and complications associated with a pre-existing ankle injury. All ten who completed the study demonstrated improved speed (pooled mean change = .13m/s) and walking endurance (pooled mean change = 117ft.). Six participants improved one functional ambulation category1 and 7 participants met the threshold for MCID2 for the 10MWT.   Eight demonstrated improved endurance greater than the SEM4 on the 6minWT3, but only 2 exceeded the MCID threshold. Five participants demonstrated a pre-post change in WISCI II exceeding the SRD5.

Conclusion: Individuals with chronic motor incomplete SCIs may benefit from step ergometry training with ES as an adjunct to over ground gait training to improve walking recovery.

Clinical Relevance: Many individuals who present with motor incomplete SCIs are not able to regain the ability to walk independently due to poor strength, poor endurance and poor speed. The addition of ES has shown beneficial in walking recovery post SCI6-11, but very few studies stimulated 12 muscles while training in an upright environment followed by task-specific walking training. This novel approach may provide clinicians with more options to improve walking function for individuals who have not responded to more conventional forms of locomotor training after SCI.

Tefertiller, Candy R, DPT, NCS; Gerber, Don , PsyD ANPP. Walking-Related Outcomes for Individuals with Motor Incomplete Spinal Cord Injuries (SCIs) : 12 weeks of Step Ergometry Training in Combination with Electrical Stimulation (ES).. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/054_tefertiller-gerber/