Gait Improvements With BWSTT For Incomplete SCI One Year Post-injury

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PURPOSE: The purpose of this case study is to highlight the use of Body Weight Support Treadmill Training (BWSTT) to improve gait deficits in an incomplete spinal cord injury (SCI) patient one year post-injury. METHODS: RC is a 60 y/o female who sustained a cervical SCI. Initial diagnosis was C4, ASIA C incomplete injury, which was later changed to ASIA D due to improvements. One year and four months after the initial injury, RC received BWSTT to improve gait. BWSTT was implemented 2x/week for 8 weeks. Initial treatments involved 8 minutes at 0.8 mph based on the patients endurance with offloading to normalized gait pattern with tactile facilitation of the lower extremities. The gait speed was gradually increased and offloading gradually decreased as RC improved throughout the sessions. RESULTS: At baseline, RC demonstrated decreased arm swing, decrease left step length with left foot not advancing past the right foot, and a gait speed of 0.17 m/s. Within a 50 foot walking distance, RC lost her balance three times, two of which she was able to independently recover and one of which required minimal assistance to regain her balance. After 8 weeks, RC’s gait speed improved to 0.6 m/s. Within a 50 foot walking distance, RC demonstrated improved arm swing, and increased left step length with the left foot advanced beyond the right foot. Her gait speed improved from a household ambulator to a limited community ambulator. At an 18 week follow up, the patient's gait speed was 0.42 m/s. Although the patient did regress in her gait speed, she still maintained a speed more than twice as fast as her baseline speed and remained a limited community ambulator. CONCLUSIONS: BWSTT has the potential to improve the speed and quality of gait in an incomplete spinal cord injury even after a year post-injury. RC’s ability to receive continued physical therapy services was limited by insurance and cost, but she was able to receive ongoing BWSTT through the university pro bono services. Future studies can include BWSTT beyond 8 weeks to investigate whether or not further improvements can be gained. Even with a discontinuation of BWSTT, the patient was able to maintain a higher walking speed compared to baseline at 4 months after treatments.