LOCOMOTOR TRAINING EFFECTS ON PULMONARY FUNCTION, MOBILITY, AND PARTICIPATION IN FOUR CHILDREN WITH SPINAL CORD INJURY

Manella K.¹, Field-Fote E.^2,3

¹University of St. Augustine for Health Sciences, Doctor of Physical Therapy Program, Austin, United States, ²The Miami Project to Cure Paralysis, Miami, United States, ³Shepherd Center - Crawford Research Institute, Atlanta, United States

Background: Activity limitations after spinal cord injury (SCI) increase health risks for pulmonary and bowel and bladder function. In children with SCI, diminished mobility may isolate them from peers, restrict participation, and limit independence and quality of life. Locomotor training (LT) with partial body weight support (PBWS) and electrical stimulation (ES) improves walking function and strength in adults with SCI.

Purpose: This study explored the effects of LT on pulmonary function, strength, reflex activity, balance, walking, mobility, participation, and quality of life in four children with SCI.

Methods: Case 1: 14 y/o female, 1.5 yrs post onset transverse myelitis, T9, left lower extremity motor score (LEMS) 19/25. Ambulation with poor left foot clearance, limited community mobility. 36 sessions PBWS TM LT with ES to activate left tibialis anterior (TA) and soleus during swing and stance phases, respectively. Final session, participant ran on TM, 5.0 mph without PBWS for 3 minutes. Case 2: 9 y/o male, 4 yrs post SCI, T8, LEMS 3/50. Independent wheelchair (W/C) mobility in school and community. Indoor ambulation with reciprocating gait orthosis (RGO), crutches, stand by assist (SBA). 32 sessions PBWS TM LT with whole body vibration (WBV) prior to LT and vibration to bilateral tensor fascia lata (TFL) during LT. Final session, exhibited independent stepping on TM, 40% PBWS at 2.0 mph compared to session 1 with maximal manual assisted stepping, 60% PBWS at 0.5 mph. Case 3: 7 y/o female, 4 yrs post SCI, level L1, LEMS 17/50. Independent W/C mobility in school and community. Independent indoor ambulation with bilateral ankle foot orthoses and rolling walker (RW). 33 sessions PBWS TM LT with ES to bilateral common peroneal nerves to activate TA and flexor reflex at swing phase onset. Final session, exhibited independent stepping on TM, 20% PBWS at 2.3 mph compared to session 1 with maximal manual assisted stepping, 50% PBWS at 0.5 mph. Case 4: 10 y/o male, 5 years post SCI, MVA, level T8 – T10, LEMS 4/50. Supervised W/C mobility at school and community. Indoor ambulation with RGO, RW, SBA. 33 sessions PBWS TM LT and vibration protocol. Final session exhibited independent stepping overground, 30% PBWS, with RW, minimal assist, and 100 meters distance.

Results: Improved LEMS 4/4 cases, reflex modulation 2/2 cases, walking function 3/3 cases. Improved chest expansion, balance, gross motor function and mobility 3/4 cases. Improved pulmonary capacity and functional mobility 2/4 cases.

Conclusion(s): LT appears to improve pulmonary function, strength, reflex modulation, balance, walking and functional activity level in children with SCI. These outcomes warrant further investigation of LT effects in children with SCI.

Implications: LT with stimulation-assisted stepping (FES or vibration protocol) appears to have some beneficial effect on pulmonary function, lower extremity strength, lower extremity flexor and extensor reflex modulation, walking speed, and functional mobility in children with incomplete SCI. Further research is warranted to investigate the effects of LT and the contribution of FES and vibration assisted stepping to change in body function impairments, activity limitations, and participation restrictions in children with spinal cord injury.

Funding acknowledgements: Internally funded by University of Miami and The Miami Project to Cure Paralysis

Topic: Neurology: spinal cord injury

Ethics approval: Complied with Declaration of Helsinki standards and was approved by the University of Miami Human Subjects Research Office

All authors, affiliations and abstracts have been published as submitted.