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Locomotor Training After Human Spinal Cord Injury: A Series of Case Studies

AL Behrman, PT, PhD, is Assistant Professor, Department of Physical Therapy and University of Florida Brain Institute, University of Florida, Box 100154, Gainesville, FL 32510-0154 (USA) (abehrman{at}hp.ufl.edu). Address all correspondence to Dr Behrman
SJ Harkema, PhD, is Assistant Professor, Department of Neurology and Brain Research Institute, University of California at Los Angeles, Los Angeles, Calif

Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. Mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as ASIA A, subject 2 had a T5 injury classified as ASIA C, subject 3 had a C6 injury classified as ASIA D, and subject 4 had a T9 injury classified as ASIA D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.

Key Words: Locomotion • Recovery • Spinal cord injury