An Intensive Intervention for Improving Gait, Balance, and Mobility in Individuals With Chronic Incomplete Spinal Cord Injury: A Pilot Study of Activity Tolerance and Benefits

Fritz SL, Merlo-Rains AM, Rivers ED, Peters DM, Goodman A, Watson ET, Carmichael BM, McClenaghan BA. An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits.ObjectiveTo determine the tolerance to and benefits of an intensive mobility training (IMT) approach for individuals with incomplete spinal cord injury (ISCI).DesignProspective pretest-posttest study with 6-month follow-up.SettingUniversity research laboratory.ParticipantsA volunteer sample of individuals with ISCI (N=15; >6mo postinjury and able to walk at least 3.05m with or without assistance). Follow-up data were collected for 10 of the participants.InterventionsParticipants received IMT for 3h/d for 10 weekdays, participating in activities that encouraged repetitive, task-specific training of their lower extremities in a massed practice schedule.Main Outcome MeasuresAmount of time spent in therapeutic activities and rest was used to assess participants' tolerance to the intervention. Treatment outcomes were assessed pretest, posttest, and 6 months after the intervention and included the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), 6-minute walk test, gait speed, and Spinal Cord Injury Functional Ambulation Inventory.ResultsIndividuals in the higher functioning ISCI group (BBS score ≥45 and gait speed ≥0.6m/s) spent more time in the intensive therapy on average than individuals in the lower functioning ISCI group. Effect sizes were comparable for changes in balance and mobility assessments between the lower and higher functioning groups, with the largest effect sizes observed for the DGI.ConclusionsThis dosage of IMT may be a more appropriate treatment approach for higher functioning ISCI individuals, as they were better able to tolerate the length of the session and demonstrated higher effect sizes postintervention.