Providing locomotor training to people with spinal cord injury to improve walking ability

Mehrholz J, Kugler J, Pohl M

Published Online:

October 8, 2008

There is insufficient evidence to conclude that one locomotor training strategy is more effective than another for improving walking ability in people with spinal cord injury (SCI).

Improvement of locomotor function is one of the primary goals for people with SCI. Many strategies exist to improve this function, such as treadmill training with and without body weight support, robotic-assisted gait training and functional electrical stimulation. This review found insufficient evidence to conclude which locomotor training strategy improves walking function most for people with SCI.

Abstract (click to read)

Background:

Locomotor training for walking is used in rehabilitation after spinal cord injury (SCI) and might help to improve walking.

Objectives:

To assess the effects of locomotor training on improvement in walking for people with traumatic SCI.

Search strategy:

We searched the Cochrane Injuries Group Specialised Register (last searched June 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2); MEDLINE (1966 to June 2007); EMBASE (1980 to June 2007); National Research Register (2007, Issue 2); CINAHL (1982 to June 2007); AMED (Allied and Complementary Medicine Database) (1985 to June 2007); SPORTDiscus (1949 to June 2007); PEDro (the Physiotherapy Evidence database) (searched June 2007); COMPENDEX (engineering databases) (1972 to June 2007); INSPEC (1969 to June 2007); and the National Research Register, Zetoc, and Current Controlled Trials research and trials registers. We also handsearched relevant conference proceedings, checked reference lists and contacted study authors in an effort to identify published, unpublished and ongoing trials.

Selection criteria:

We included randomised controlled trials (RCT) that compared locomotor training to any other exercise provided with the goal of improving walking function after SCI or to a no-treatment control group.

Data collection and analysis:

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcomes were the speed of walking and walking capacity at follow up.

Main results:

Four RCTs involving 222 patients were included in this review. Overall, the results were inconclusive. There was no statistically significant effect of locomotor training on walking function after SCI comparing bodyweight supported treadmill training with or without functional electrical stimulation or robotic-assisted locomotor training.

Authors' conclusions:

There is insufficient evidence from RCTs to conclude that any one locomotor training strategy improves walking function more than another for people with SCI. Research in the form of large RCTs is needed to address specific questions about the type of locomotor training which might be most effective in improving walking function of people with SCI.

This record should be cited as:

Mehrholz J, Kugler J, Pohl M. Locomotor training for walking after spinal cord injury. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006676. DOI: 10.1002/14651858.CD006676.pub2

Assessed as up to date:

December 16, 2007

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Primary Review Group:

Injuries Group

Health topics:

Neurology > Spinal cord injury

Orthopaedics & trauma > Spinal cord injury

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Providing locomotor training to people with spinal cord injury to improve walking ability

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