A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury

Abstract

Objective: To systematically review the evidence for the efficacy of different rehabilitation strategies on functional ambulation following spinal cord injury (SCI). Method: A key word literature search of original articles was used to identify published literature evaluating the effectiveness of any treatment or therapy on functional ambulation in people with SCI. The rigor and quality of each study were scored on standardized scales by two independent reviewers. Results: The search yielded 160 articles, of which 119 were excluded for not meeting inclusion criteria. The remaining 41 articles covered various strategies for improving gait: body-weight-supported treadmill training (BWSTT) (n = 12), functional electrical stimulation (FES) (n = 7), braces/orthoses (n = 10), or a combination of these (n = 12). There is strong evidence from randomized controlled trials that functional ambulation outcomes following BWSTT are comparable to an equivalent intensity of overground gait training in subacute SCI. In chronic SCI, evidence from pretest/posttest studies shows that BWSTT may be effective in improving functional ambulation. Pretest/posttest or posttest-only studies provide evidence that FES may augment functional ambulation in persons with subacute/chronic SCI, whereas braces may afford particular benefits to people with complete SCI to stand up and ambulate with assistive devices. Conclusion: Rehabilitation strategies that facilitate repeated practice of gait offer the greatest benefits to functional ambulation in subacute or chronic SCI. Supportive devices may augment functional ambulation particularly in people with incomplete SCI. © 2007 Thomas Land Publishers, Inc.