Treadmill training after spinal cord injury: Good but not better

To the Editor:

The editorial by Dr. Wolpaw highlights the significance of the first multi-randomized clinical trial (MCRCT) for neurorehabilitation after acute spinal cord injury (SCI).¹ Several therapeutic implications of the trial that were not addressed warrant discussion.

In this trial, the effect of body weight supported treadmill training (BWSTT) was compared to a control overground mobility training (CONT), not to conventional rehabilitation for individuals with incomplete SCI. A large sample of people with typical ASIA B, C, and D injuries received standing and gait training. The experimental arm received BWSTT followed by immediate practice overground. Training afforded the sensory-specific experience of walking and emphasized weight-bearing on the legs. The control group received overground standing and usual gait training. Both groups received 40 to 60 training sessions, a higher frequency than is typically provided.

The MCRCT demonstrated for the first time that ASIA C and D subjects in both groups achieved significant gains 6 months after study entry. Most subjects attained abilities sufficient for community ambulation including a fast speed (1.0 m/s), relatively good endurance (400 m in 6 min) without walking aids, and excellent balance (54/56 Berg balance). Therefore, the trial demonstrates that aggressive rehabilitation in the early phase of SCI is likely to benefit a very high percentage of these individuals. Specifically, these results suggest that at least one h/day of weight-bearing standing and gait training should be emphasized as early as possible for up to 60 sessions, likely resulting in a progressive increase in walking speed over time, but this relationship requires further investigation.

The findings of the current clinical trial now set the minimum recovery standards by which all …