10 | Walking Recovery

Regaining the ability to walk seems to be a major long-term goal of persons with spinal cord injury (SCI).1 Considering this and findings that persons with an incomplete SCI are likely to regain some level of walking ability, 2 3 4 exploring ways to facilitate “walking recovery” would be important in rehabilitation management.1 5

I’ve learned so much over the past six months  – my injury has actually turned into a real opportunity for me.

Simon

Five months into Simon’s rehabilitation, a Rehab-Cycle^® began that focused on furthering the recovery of his walking ability. To start off the Rehab-Cycle^® an assessment of Simon's functioning was conducted as the basis for defining the goals to address in rehabilitation.

While the broad goals of community integration and independent living are common long-term goals set by persons with spinal cord injury (SCI), the steps toward reaching these goals can differ greatly from person to person.

For each intervention target, appropriate interventions were identified and assigned to one or more of Simon’s rehabilitation team members.

I never expected to make so much progress so quickly. Now I can swim and ride a bike, but there are still some challenges. I’m nervous while swimming and can’t yet get onto a mountain bike, which I find really disappointing. But I know these will also improve with time and practice.

Simon at the end of the Rehab-Cycle^®

Rehabilitation incorporating walking as a goal requires both the guidance and support of the rehabilitation team and the focus and determination of the injured person.

1. Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord. 2008; 46: 500-506.
2. Burns SP, Golding DG, Rolle WA, Graziani V, Ditunno JF. Recovery of ambulation in motor-incomplete tetraplegia. Arch Phys Med Rehabil. 1997(11); 78:1169-1172.
3. Ditunno JF, Ditunno PL, Graziani V, Scivoletto G, Bernardi M, Castellano V, Marchetti M, Barbeau H, Frankel HL, D'Andrea Greve JM, Ko HY, Marshall R, Nance P. Walking index for spinal cord injury (WISCI): An international multicenter validity and reliability study. Spinal Cord. 2000; 38: 234-243.
4. Lam T, Noonan VK, Eng JJ, SCIRE Research Team. A systematic review of functional ambulation outcome measures in spinal cord injury. 2008; 46(4); 246-254.
5. Barbeau H, Ladouceur M, Norman KE, Pépin A. Walking after spinal cord injury: Evaluation, treatment, and functional recovery. Arch Phys Med Rehabil. 1999; 80: 225-235.
6. Sutherland DH. Events measurements in normal and pathological gait. Bulletin of Prosthetics Research (now J Rehabil Res Dev). 1981; BPR 10-35/18(1): 281-282.
7. Lajoie Y, Barbeau H, Hamelin M. Attentional requirements of walking in spinal cord injured patients compared to normal subjects. Spinal Cord. 1999; 37: 245-250.
8. Chester VL, Biden EN, Tingley M. Gait analysis. Biomed Instr Tech. 2005; 39: 64-74.
9. Harkema SJ, Dobkin BH, Edgerton VR. Pattern generators in locomotion: Implications for recovery of walking after spinal cord injury. Topics Spinal Cord Inj Rehab. 2000; 6(2): 82-96.
10. Yang JF, Gorassini M. Spinal and brain control of human walking: Implications for retraining of walking. Neuroscientist. 2006; 12(5): 379-389.
11. Brotherton SS, Krause JS, Nietert PJ. Falls in individuals with incomplete spinal cord injury. Spinal Cord. 2007; 45(1): 37-40.
12. Harkema SJ. Neural plasticity after human spinal cord injury: Application of locomotor training to the rehabilitation of walking. Neuroscientist. 2001; 7(5): 455-468.
13. Grasso R, Ivanenko YP, Zago M, Molinari M, Scivoletto G, Castellano V, Macellari V, Lacquaniti F. Distributed plasticity of locomotor pattern generators in spinal cord injured patients. Brain. 2004; 127: 1019-1034.
14. Dobkin B, Apple D, Barbeau H, Basso M, Behrman A, Deforge D, Ditunno J, Dudley G, Elashoff R, Fugate L, Harkema S, Saulino M, Scott M. Spinal Cord Injury Locomotor Trial Group. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology. 2006; 66(4): 484-493.
15. Mehrholz J, Kugler J, Pohl M. Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev. 2012; 11(2): CD006676.
16. van Hedel HJ. Improvement in function after spinal cord injury: the black-box entitled rehabilitation. Swiss Med Wkly. 2012; 142 (w13673): 1-14.
17. Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM. Clinical reasoning strategies in physical therapy. Phys Therapy. 2004; 84(4): 312-330.
18. Jones M, Edwards I, Gifford L. Conceptual models for implementing biopsychosocial theory in clinical practice. Manual Therapy. 2002; 7(1): 2-9.
19. Jones M, Rivett D. Introduction to clinical reasoning. In: Jones M, Rivett D. Clinical reasoning for manual therapists. Edinburgh, UK: Butterworth Heinemann. 2004.
20. Stucki G, Melvin J. The international classification of functioning disability and health: a unifying model for the conceptual description of physical and rehabilitation medicine. J Rehabil Med. 2007; 39(4): 286-292.
21. Sackett DL, Rosenberg WC, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: What it is and what it isn't. BMJ. 1996; 312(7023): 71-72.
22. The Cochrane Collaboration. About us. [Internet] July 2015. Available from: http://www.cochrane.org. Accessed July 2015.
23. Miller W, Chan C. Spinal Cord Independence Measure (SCIM). [Internet] 1 February 2013. Available from: http://www.scireproject.com/outcome-measures-new/spinal-cord-independence-measure-scim. Accessed 2015.
24. Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database Syst Rev. 2000; Issue 2: CD001131.
25. Bauer H, Appaji G, Mundt D. VOJTA neurophysiologic therapy. Indian J Pediatr. 1992; 59(1): 37-51.
26. Vojta V and Peters A. The Vojta Principle. Muscle activity in reflex progressive movement and motor development [German: Das Vojta-Prinzip. Muskelspiele in Reflexfortbewegung und motorischer Ontogenese]. 3^rd Edition. Heidelberg, Germany: Springer Medizin Verlag. 2007.
27. International Vojta Society. The Vojta Principle. [Internet] July 2015. Available from: http://www.vojta.com/en. Accessed July 2015.