Segmental Assessment of Trunk Control in Young Children with SCI: Responsiveness to Activity-based Therapy.

Research Report
Population: Pediatric

Laura Argetsinger, DPT, Physical Therapist, Frazier Rehab Institute

Shelley Trimble, PT, Pediatric NeuroRecovery and Translational Research Specialist, Frazier Rehab Institute

MacKenzie Roberts, DPT, Research Physical Therapist, Frazier Rehab Institute

Doug Lorenz, PhD, Assistant Professor, University of Louisville

Andrea Behrman, PhD, PT, FAPTA, Professor, University of Louisville

Keywords: Plasticity, Assessment, Activity-based therapy, Spinal Cord Injury

Purpose/Hypothesis: Paralysis and weakness due to spinal cord injury (SCI) negatively impacts trunk control leading to functional deficits in sitting and hand use. Impairments are further compounded in children due to their maturing musculoskeletal system. Of children injured at age 10 years and younger, 100% will develop a scoliosis (Parent et al., 2010). Activity-Based Locomotor Training (AB-LT) targets neuromuscular activation and capacity below the lesion promoting recovery or new control. Most pediatric outcomes assess the trunk as one unit and therefore are not sensitive to small improvements. The Segmental Assessment of Trunk Control (SATCo) evaluates the trunk sequentially by assessing control at descending incremental levels and has been validated in typically developing infants and children with neuromotor disabilities (Butler et al., 2010). The purpose of this study is to determine the responsiveness of the SATCo in detecting change in trunk control in children with chronic SCI receiving AB-LT. We hypothesized that children with SCI undergoing AB-LT would demonstrate significant change in SATCo scores.
Subjects: Children with SCI enrolled in an outpatient AB-LT Program from October 2012-November 2014 at Frazier Rehab Institute.                                                Materials/Methods: Children received AB-LT for 1.5 hrs/day, 5 days/wk (Behrman et al., 2008, Harkema et al., 2011). The SATCo was administered during periodic evaluations. During testing, subjects were positioned in short sit without arm support and with manual assist for a vertical pelvis. Manual support was also given at specified segmental trunk levels while static, active and reactive control elements were scored sequentially as present, absent or not tested. To be scored as present, trunk control above the level of support had to be achieved with appropriate postural alignment.
Results: Subjects had a mean age of 5 yrs, 1 mo (range 2-8 yrs), post-SCI mean of 3 yrs (range 1 yr, 8 mos-6 yrs), with cervical (n=2) and thoracic (n=4) level injuries, and were non-ambulatory at baseline. The participants received AB-LT for a mean of 88.83 sessions (range 53-194). The SATCo was administered 4 times on each child. All subject’s scores increased from baseline to discharge, mean increase of 5.83/20 elements (range 2-9) and 2 levels (range 1-3). Scores were significantly different at the 4 evaluations; repeated measures ANOVA F3,15= 9.91, p=.00075. Scores at evaluation 4 were significantly different than at evaluation 1 (Wilcoxon signed rank test, p=.03).
Conclusion: All participants improved trunk control below lesion level after undergoing AB-LT as captured by incremental changes on the SATCo.
Clinical Relevance:
Children with the lowest initial SATCo scores and highest injury levels showed greatest improvements in trunk control after AB-LT. This is the first report of application of the SATCo in the pediatric population with SCI demonstrating its utility and impact of AB-LT on trunk control.

Argetsinger, Laura , DPT; Trimble, Shelley , PT; Roberts, MacKenzie , DPT; Lorenz, Doug , PhD; Behrman, Andrea L, PhD, PT, FAPTA. Segmental Assessment of Trunk Control in Young Children with SCI: Responsiveness to Activity-based Therapy.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.