The Effects of Two Months Body Weight Supported Treadmill Training on Balance and Quality of Life of Patients With Incomplete Spinal Cord Injury

Abstract

Objective Spinal cord injury is a major problem for all communities that affect personal and social aspects of the patient’s life. The most common issues that spinal cord injury patients face are paralysis, muscle atrophy, pain, and spasticity. The ability to walk also may be disrupted or lost in many of the patients with spinal cord injury. Most common approaches to rehabilitation for patients with spinal cord injury are the emphasis on healthy neuromuscular sections to promote these sectors and compensate existing defects. But recent studies have reported that the neuromuscular system is capable of plasticity and after spinal cord injury is necessary to pay attention to health and impaired neuromuscular parts of the body. Gait training is one of the rehabilitation approaches that is trying to recruit impaired neuromuscular parts and improve them. This rehabilitation is performed in different ways. In this study, the effect of body weight supported treadmill training on balance and quality of life in patients with incomplete spinal cord injury was evaluated. Materials & Methods This is a quasi-experimental study. Patients with incomplete spinal cord injury (n=15) aged 26 and 48 years with a chronic (>1 year post-injury), grade D=4 and C=11 (according to American spinal cord injury association scale [ASIA]) voluntarily participated in this study. Sampling was conducted from hospitals and spinal cord injury rehabilitation centers of Tehran. For intervention, the patient was in the body weight support system. Patients’ weight supported and suspended with harnesses and lifter of the body weight support system to the extent that knees were not bent in stance phase and fingers can’t be dragged into swing phase. Treadmill speed and amount of weight support adjusted depending on the patient’s conditions. Intervention applied for eight weeks and three sessions a week. Each session lasted 30 minutes. Outcome measures were Berg balance scale and SF-36 questioner. The quality of life evaluated before and after the intervention. Berg balance scale was evaluated at baseline and every two weeks throughout the intervention. The results were compared with each assessment. Repeated measure ANOVA test used for analysis of the scores of Berg balance scale and SF-36, paired t-test used. Results The evaluation results indicated that the scores of Berg balance scale, increased significantly compared to the previous stage in each reevaluation. Between the various stages of evaluation, the maximum difference was between the second and third stages (P=0.008) that were after two and four weeks after the first session respectively. The score of SF-36 showed no significant difference. Between 8 items that measured in SF-36 questioner, just score of »emotional roll functioning « increased significantly (P=0.006). Conclusion According to achieved results, eight weeks body weight supported treadmill training can improve the balance of the patients with spinal cord injury. It was observed that the gait training with stimulation and use of proprioceptors and increase of patient’s confidence in walking and standing positions improve the patient’s balance. The patients were also able to control the internal and external perturbations and maintain the better balance. But eight weeks gait training had no significant effect on the quality of life in patients with spinal cord injury which suggest that more extended rehabilitation is required.

Keywords

• Spinal cord injury
• Gait training
• Berg balance scale