Two-week intensive locomotor training improves balance and mobility of a person with chronic incomplete C4 tetraparesis

Abstract

Background: Literature supports the achievement of meaningful functional outcomes following long duration intensive locomotor training (LT). However, these long duration protocols may not be feasible in the current reimbursement environment. Purpose: To determine if similar functional gains can be achieved through a shorter duration, high intensity training in a person with chronic motor-incomplete C4 tetraparesis. Methods: The participant was a 61 year-old male with a chronic (16 months) incomplete spinal cord injury (iSCI) level C4 Asia Impairment Scale (AIS) D. He previously received 13 months of traditional outpatient physical therapy, then went on a scheduled one-month therapy hiatus before starting the intensive locomotor training program. The program consisted of ten 90-minute physical therapy sessions over two weeks. The program included the following: Body weight supported treadmill training (BWSTT) with manual assistance, overground training, and independent community integration activities. Results: At the conclusion of the intensive locomotor program, the participant had a 33% improvement in the Berg Balance Scale and Timed Up-and-Go, a 24% improvement in the six meter walk test, and a 19% increase in the World Health Organization Quality of Life (WHOQOLBREF) questionnaire. Conclusion(s): A participant with chronic (>1 yr) SCI AIS D improved in balance, walking ability and self-reported quality of life after two weeks of intensive locomotor training. These findings follow a similar trend seen in long duration protocols. Implications: This case report shows that positive functional gains in mobility, ambulation, balance and quality of life can be achieved following a short bout of intensive locomotor training. This approach may be more applicable in the current clinical environment, and could save in health care costs, thereby making the intervention more accessible for individuals with chronic motor-incomplete SCI.