According to the National Spinal Cord Injury Statistical Center, more than a quarter of a million individuals live with spinal cord injury (SCI) in the United States and each year there are approximately 12,000 new spinal cord injuries.
Approximately half exhibit incomplete injuries and hold some ability to move their leg muscles. Of those, only a small portion actually walk on a regular basis either at home or in the community. De-conditioning, or a lack of endurance and strength occurs, and SCI individuals are subject to significant secondary complications such as loss of cardiovascular fitness and increased risk of diabetes.
Several methods are available to try to improve walking ability and the fitness of persons with motor incomplete spinal cord injury; this Department of Defense sponsored study compares two of these methods.
We are investigating the impact of these two techniques on walking ability and fitness in people who have experienced motor incomplete SCI for at least 12 months.
The research will occur in two centers: Kernan Orthopedics and Rehabilitation Hospital in Baltimore, Maryland and Shepherd Center in Atlanta, Georgia. A total of 36 volunteers with motor incomplete SCI between the ages of 18 to 65 are being recruited during the 3 ½ year duration of the study. The level of injury can range from the fourth cervical level in the neck to the twelfth thoracic level in the back.
Potential volunteers must be able to commit to three therapies per week for a total of seven months, to tolerate standing in a standing frame for at least 30 minutes, and to have not participated in Lokomat or aquatic exercise in the past 6 months. Individuals will be assessed by a physician to determine their eligibility for the study and if participating in this type of exercise would be safe. The risks associated with this type of study are similar to any type of cardiovascular exercise.
Half of the group will start with the Lokomat training and half will start with aquatic exercise. Each group will then switch to the other exercise condition. Exercise sessions will occur three times per week, last approximately 45-55 minutes, and a physical therapist will provide personal direction throughout the sessions. Walking ability and cardiovascular fitness, as well as muscle strength will be assessed before starting exercise, at the three-month point and then at the six month point.
This type of research is important to better understand how best to prescribe exercise treatments to people with spinal injury. Studies in a chronic SCI population using body weight supported locomotor training are required to further evaluate its effectiveness. In addition, the rigorous assessment of aquatic exercise, which is already available in many communities, may expand the fitness opportunities for individuals with incomplete spinal cord injury.