The Authors Respond: Balance and Ambulation Improvements in Individuals With Chronic Incomplete Spinal Cord Injury Using Locomotor Training-Based Rehabilitation

Abstract

Dobkin and Elashoff raise a number of points about our article 1 Harkema S. Schmidt-Read M. Lorenz D. Edgerton V. Behrman A. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation. Arch Phys Med Rehabil. 2011 Jul 19; ([Epub ahead of print]) Google Scholar that recently appeared in the Archives that will benefit from some discussion, and we will address them below. Their editorial comments are essentially based on the assumption that the objective of our study was to scientifically test the impact of locomotor training, and thus a randomized controlled trial was required. Although the former is desirable, it is not the only type of study that can provide valuable information that can be used to improve clinical practice. Important insight can be gained even from a case study, and clinically relevant outcomes can be missed if only a sole primary outcome measure is considered. 2 Harkema S. Gerasimenko Y. Hodes J. et al. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet. 2011; 377: 1938-1947 Abstract Full Text Full Text PDF PubMed Scopus (662) Google Scholar Quasi-Experimental Study of Weight-Supported Treadmill Training for MyelopathyArchives of Physical Medicine and RehabilitationVol. 93Issue 5PreviewIn their exploratory, cohort report using body weight–supported treadmill training (BWSTT) in persons with nonprogressive spinal cord injury (SCI), Harkema et al1 state, “There is a need to evaluate the effectiveness of locomotor training by using a standardized protocol and outcomes with a large sample of participants with upper motor neuron, incomplete SCI.” For this rationale, the Reeve Foundation funded 7 sites (NeuroRecovery Network [NRN]) to treat 196 patients graded C and D on the American Spinal Injury Association Impairment Scale (AIS). Full-Text PDF