A comparison of one year outcomes between standardized locomotor training and usual care after motor incomplete spinal cord injury: Community participation, quality of life and rehospitalization (original) (raw)
Related papers
Indian Journal of Physical Medicine and Rehabilitation, 2019
Background: The incidence of spinal cord injury (SCI) varies but is estimated at 10-83 per million per year with most injured under the age of 25 years. Rehabilitation constitutes an important element of management of traumatic SCIs. However, due to lack of resources and awareness, this aspect is often neglected in developing countries. This results in poor functional outcome. Objectives: The study was conducted to assess functional improvement, in the form of self-care, transfer, and mobility pre and post a multipronged rehabilitation program in patients with SCI. The study also evaluated the impact of rehabilitation program in achieving different levels of independence, in SCI patients. Materials and methods: A prospective observational study carried out over the period of 1 year at a tertiary teaching hospital. Twenty patients with traumatic SCIs were included in the study and underwent a multipronged rehabilitation program. The program was specifically designed and tailored to ensure bedside mobility initially and then progressing to transfer and ambulatory training, and activity of daily livings (ADLs). Results: All patients showed improvements in functional outcome. The spinal cord independence measure (SCIM) showed a significant improvement in all areas of self-care, sphincter management, indoor and outdoor mobility. Ambulation status improved as a result of the program. Conclusion: A well-designed rehabilitation program has a significant impact on the functional outcome of patients with SCI. Rehabilitation should be promoted even if delayed in such patients.
Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury
Physical Therapy, 2005
Background and Purpose. The use of locomotor training with a body-weight–support systemand treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report isto describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Case Description. Following discharge from rehabilitation, a man with an incomplete SCI at C5–6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45sessions of locomotor training. Outcomes. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for communitymobility. Walking activity (X̄±SD) per 24 hours increased from 1,054±543 steps to 3,924±1,629 steps. Discussion. In a person with an incomplete SCI, walki...
The journal of spinal cord medicine, 2009
To explore the association of mode of locomotion (ambulation vs wheelchair use) and independence in locomotion (independent vs require assistance) with health, participation, and subjective well-being (SWB) after spinal cord injury (SCI). Secondary analysis was conducted on survey data collected from 2 rehabilitation hospitals in the Midwest and a specialty hospital in the southeastern United States. The 1,493 participants were a minimum of 18 years of age and had traumatic SCI of at least 1 year duration at enrollment. Three sets of outcome measures were used: SWB, participation, and health. SWB was measured by 8 scales and a measure of depressive symptoms, participation by 3 items, health by general health ratings, days in poor health, hospitalizations, and treatments. Small but significant associations were observed between independence in locomotion and every outcome. Ambulation was associated with greater participation but a mixed pattern of favorable and unfavorable health and...
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2017
Objectives: This study aims to analyze the demographic and clinical properties of patients with spinal cord injury (SCI) and to investigate the functional outcomes after rehabilitation. Patients and methods: In this retrospective and descriptive study, we investigated a total of 118 SCI patients (74 males, 44 females; mean age 41±16 years; range 13 to 74 years) with full records who were admitted to our rehabilitation program between January 2005 and December 2010. Demographic characteristics of the patients, etiological factors, time since injury, length of hospital stay, level of injury, as assessed by the American Spinal Injury Association (ASIA) Impairment Scale and functional status, as assessed by the Functional Independence Measure (FIM TM) on admission and discharge were analyzed. Complications related to SCI were also noted. Characteristic features of the patients', frequency of complications, and functional and neurological recovery were evaluated. Results: Of the patients, 70% were tetraplegic. The median time since injury was four months (IQR: 1 to 15 months), while the median length of stay was 76 days (IQR: 46 to 104 days). Four of 47 patients (8%) with Grade A (complete) according to the ASIA Impairment Scale on admission progressed to Grade B on discharge. Functional independence measure motor scores showed significant improvements at discharge (p<0.0001). The most common complications were urinary tract infections (70%), pressure ulcers (31%), and pain (28%). Conclusion: Inpatient rehabilitation in a tertiary referral hospital appears to provide substantial functional and motor gains in patients with SCI. Based on our study results, considerable improvement in the activities of daily living, as assessed by FIM motor scores, can be achieved with rehabilitation.
The Journal of Spinal Cord Medicine, 2012
Objectives: To describe and compare patient demographics, inpatient lengths of stay (LOS), and walkingrelated functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and nontraumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. Design: Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. Setting: Rehabilitation hospital specialized for SCIs. Participants: Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. Outcome measures: Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. Results: Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). Conclusion: Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.
Spinal Cord, 2010
Study design: A prospective study. Objectives: To evaluate the changes of functional abilities, incidences of complications and falls of patients with spinal cord injury (SCI) 6 months after discharge. Setting: A major tertiary referral hospital, Thailand. Methods: Forty-four patients with SCI completed the study. Their average age and post-injury time were 45.23±13.78 years and 51.52±47.87 months respectively. Functional abilities of the subjects were measured by using the Spinal Cord Independence Measure II (SCIM II). Incidences of complications and falls were prospectively assessed every month by using a questionnaire. Results: After 6 months, the SCIM II scores of subjects showed a slight decrease (58.60 ± 21.22-58.37±22.06 scores). The significant decrement was illustrated in self-care and mobility scores of subjects with chronic motor incomplete SCI (Po0.05). Forty subjects experienced at least one medical complication (range 1-5 times) which 11 of them had to re-admit for 3-30 days. Twenty-four subjects sustained at least one fall in 6 months (range 1-24 times) which one subject had metatarsal bone fracture after fall. Conclusion: The functional ability of subjects with SCI, particularly those with chronic motor incomplete SCI, significantly decreased after discharge. The subjects also encountered a high risk of complications and falls that might associate with the decrement of functional ability. The findings confirmed important roles of community rehabilitation after discharge.
Disability and rehabilitation, 2017
Locomotor training after incomplete spinal cord injury can improve walking function, and cardiovascular and muscle health. Participants' perspectives about locomotor training, however, have not been extensively studied. This study describes the experiences of individuals with sub-acute incomplete spinal cord injury who completed personalized adapted locomotor training; a locomotor-focused rehabilitation tailored to individual goals. Specifically, we examined how participation in this training impacted their lives and what challenges they encountered. Following inpatient rehabilitation, seven participants completed 74-197 h of personalized adapted locomotor training. Using conventional content analysis, themes were identified from post-training interviews. Trustworthiness was enhanced through analysis trials, verbatim quotes, and triangulation. Three themes emerged: motives for participating, perceived benefits, and perceived challenges. Beliefs that higher intensity leads to qui...
2021
ObjectiveActivity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT) is an innovative technique that aims to enhance rehabilitation outcomes, however, its efficacy in SCI rehabilitation, particularly within a low-middle income setting, is currently unclear. The primary aim of this study was to determine the feasibility of a locomotor training program within XX, in terms of recruitment, attendance, drop-out rates and safety. Secondary aims were to determine the effects of RLT compared to ABT on functional capacity in people with chronic SCI.DesignParticipants with chronic traumatic motor incomplete tetraplegia (n = 16) were recruited. Each intervention involved 60-minute sessions, 3x per week, over 24-weeks. RLT involved walking in the Ekso GT™ suit. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. Primary feasibility outcomes included recruitment rate, adherence rate, and adverse ...