High intensity body weight support treadmill training induces long-term walking performance improvement without spasticity increase after chronic incomplete spinal cord injury

Abstract

Body Weight Support Treadmill Training (BWSTT) has shown walking improvement after incomplete spinal cord injury (SCI) but its effect on spasticity remains unaddressed. The aim of this study was to assess the BWSTT effects on both walking performance and spasticity of patients suffering from incomplete SCI. Two patients were included: a tetraplegic female (S1) and a paraplegic male (S2) with incomplete chronic SCI (AIS D) respectively 30 and 45 years old. The program consisted in 20 BWSTT sessions of one hour, scheduled 5 days a week lasting 4 weeks. Two pre-tests 4 weeks apart were performed in order to establish a baseline before the BWSTT. We assessed the intervention effects with two post-tests, performed immediately after BWSTT and nine months later. Measures consisted in kinematic gait recording, six Minutes Walking Test (6MWT) and spasticity assessment using the Ashworth Modified Scale. Motor performances were stable during baseline. Immediately after BWSTT, gait speed increased respectively for S1 and S2 by 25% and 33% (from 0.61 to 0.80 ms −1 and 0.64 to 0.79 ms −1 ). Similarly, 6MWT distance increased from 198 to 337 m (S1) and 270 to 353 m (S2). Nine months after BWSTT, gait speed further improved by 21% and 5% (0,98ms −1 –S1) et 5% (0,83ms −1 –S2). Participants walked 600 m (S1) and 445 m (S2) during the 6MWT. Angular kinematic evidenced a shift toward normalization particularly altering knee and ankle joints on both patients. Spasticity remained unchanged after BWSTT. Classical rehabilitation results in walking performance stability at chronic stage. In two participants with chronic incomplete SCI, BWSTT demonstrated an additional improvement of both gait performance and quality without spasticity increase. A one-month program based on BWSTT can be proposed to walking patients with incomplete chronic SCI in order to enhance gait speed, improve motor control and efficiency of walking without spasticity enhancement.