Durability of Improved Trunk Control Following Activity-Based Locomotor Training in Children With Acquired Spinal Cord Injuries

Abstract

Background: A recent study in pediatric spinal cord injury (SCI) demonstrated activity-based locomotor training (ABLT) improved trunk control, measured by the Segmental Assessment of Trunk Control (SATCo). It is not known whether improved trunk control is maintained and, if so, for how long. Objectives: The purpose was to determine the durability of improvements in trunk control after ABLT is stopped. We hypothesized that SATCo scores at follow-up would not significantly regress (a) beyond the score measured at discharge and (b) to the initial SATCo pre-ABLT level. Methods: Patients were assessed pre ABLT, after completing an episode of care, and upon returning to the clinic 1 or more months without ABLT. Durability is a score change less than 3, which is the measurement error of the SATCo. Results: Twenty-eight children (10 females; 4 ± 2.5 years old) completed at least 40 sessions of ABLT and returned for the follow-up 8 ± 7 months (range, 1–38) after the episode of care. Trunk control improved 6 ± 3/20 points with ABLT (p < .0001). At the follow-up, average SATCo score decreased 2 ± 2/20 points, and the follow-up SATCo score was 4 ± 3 points higher than pre ABLT (p < .0001). There was no correlation between the change in SATCo scores and changes in age, weight, height or elapsed time between discharge and follow-up. Conclusion: Improvements in trunk control due to ABLT were maintained, indicating ABLT is neurotherapeutic. Although not achieving complete recovery of trunk control, the immediate effects and sustained improvements provide support for a clinical shift to neurotherapeutic approaches and for continued research to achieve enhanced recovery.

Entrenamiento locomolocomo basado en la actividad: mejorar el movimiento en niños con lesión medular

“…The study by Harkema et al 22 indicated that rehabilitation that includes intensive activity-based therapy can result in functional improvements in individuals with chronic incomplete SCI. The study by Lucas et al 23 reported that the improvements in children with acquired SCI following ABLT were maintained, indicating that the program is neurotherapeutic. While not achieving complete recovery of trunk control, the immediate effects and sustained improvements provide support for a clinical shift to neurotherapeutic approaches and for continued research to achieve enhanced recovery.…”

Recovery of walking in nonambulatory children with chronic spinal cord injuries: Case series

“…Improved postural control is likely an effect of spinal plasticity associated with locomotor training, as opposed to a direct association with improved locomotor capacity. Children with SCI (Argetsinger et al, 2019; Behrman et al, 2019) demonstrated improved postural control in sitting following 20, 40, and 60 sessions of activity‐based locomotor training without changes in locomotor capacity (e.g., remained nonambulatory), as well as durability of effects without change in locomotor capacity (Lucas et al, 2022). Activity‐based therapies capitalize on the automaticity of the neural circuitry of the spinal cord to synthesize and interpret the ensemble of sensory information associated with upright posture and stepping to generate postural and locomotor tasks, even below the lesion (Roy et al, 2012).…”