Walking Rehabilitation: Some Kids May Be Overlooked

The traditional way to predict whether children can regain movement after spinal cord injuries may exclude a small subset of patients who could benefit from therapy, according to two studies presented by researchers.

In one study, researchers present details of a child with incomplete spinal cord injury who continues to improve four years after recovering walking ability in a locomotor training program at University of Florida, even though clinical assessment tools predicted he would never walk again.

In another presentation, the scientists discussed findings in which three of six children with severe, chronic and incomplete spinal cord injuries - patients who retain some sensation or movement below the injury - improved through locomotor training, to the point where they could take steps. Even the three who did not regain stepping ability acquired greater trunk control.

"The prevailing clinical view is patients who are able to recover need to display early leg movement," said Dena Howland an associate professor of neuroscience with the College of Medicine. "The children in our studies displayed minimal or no movement, yet some were still able to make significant improvement."

One study participant was a 4-year old boy who received a disabling cervical spinal cord injury at the age of 3. Before he began in the locomotor training program, a clinical measure known as the lower extremity motor score predicted he would not recover walking. He had not walked for the 16 months since his injury.

Then, for 76 sessions, the child participated in the program of locomotor training run by Behrman and Howland and their research team. The training takes a task-specific, intense repetitive practice approach with the goal of activating the neuromuscular system essential for walking.

The child was evaluated one month after locomotor training and then annually for four years. With the help of a rolling walker, he walks independently and can achieve speeds of nearly two-thirds of a meter per second. Without further training, he learned to pedal a tricycle, crawl, climb stairs and swim. He reported improved bladder sensation and attended elementary school full time without a wheelchair.

But, despite his functional improvements, his lower extremity motor score never changed — he remains unable to perform isolated leg joint movements even though he walks full time.

REHACARE.de; Source: University of Florida

( Source: REHACARE.de )

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