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 University of Florida (UF) researchers at the Society for Neuroscience meeting in San Diego.
In one study, researchers present details of a child with incomplete spinal cord injury who continues to improve 4 years after recovering walking ability in a locomotor training program at UF, 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 research was part of the Kids Step Study conducted at UF and Brooks Rehabilitation led by Andrea Behrman, PhD, PT, an associate professor of physical therapy in the College of Public Health and Health Professions, and Dena Howland, PhD, an associate professor of neuroscience with the College of Medicine.
“The prevailing clinical view is patients who are able to recover need to display early leg movement,” Howland stated in a press release. “The children in our studies displayed minimal or no movement, yet some were still able to make significant improvement.”
The locomotor training run by Behrman and Howland takes a task-specific, intense repetitive practice approach with the goal of activating the neuromuscular system essential for walking.
“The idea is that there may be a small subset in the spinal cord injury population that can benefit from training whom we have not identified, and the reason we have not identified them is that the traditional way isn’t informing us,” Behrman said. “These are all severely injured kids. Just think across the lifespan of a child who may be 3 or 6 or 10 years old at the time of injury, what a difference it would make if they could regain a fraction of mobility. Even better trunk control means quite a bit — pushing a wheelchair, or sitting behind a desk more comfortably, can be very important.”
The results of these studies suggest locomotor training and walking recovery may be linked to the development of other rhythmic, reciprocal lower extremity tasks that together promote healthy growth and development.
“This doesn’t mean all kids with these severe injuries can improve from this intervention, but there is likely a subpopulation that can regain mobility, whether walking or trunk control,” Behrman said. “Our aim is to provide clinicians with a means to identify who may benefit among the population with spinal cord injury and thus predict who will respond.”