Methods for a Randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury

The authors describe the rationale and methodology,of the first prospective, multicenter, randomized clinical trial (RCT) of a task-oriented walking intervention for subjects during earl)) rehabilitation for an acute traumatic spinal cord injury (SCI). The experimental strategy, body weight-supported treadmill training (BWSTT), allows physical therapists to systematically train patients to walk on a treadmill at increasing speeds typical of community ambulation with increasing weight bearing. The therapists provide verbal and tactile cues to facilitate the kinematic, kinetic, and temporal features of walking. Subjects were randomly assigned to a conventional therapy program for mobility versus the same intensity and duration of a combination of BWSTT and over ground locomotor retraining. Subjects bad an incomplete SCI (American Spinal Injury Association grades B, C, and D) from C-4 to T-10 (upper motoneuron group) or from T-11 to L-3 (lower motoneuron group). Within 8 weeks of a SCI, 146 subjects were entered for 12 weeks of intervention. The 2 single-blinded primary outcome measures are the level of independence for ambulation and for those who are able to walk, the maximal speed for walking 50 feet, tested 6 and 12 months after randomization. The offers a model for the feasibility of trial's methodology translating neuroscience c experiments into a RCT to develop evidence-based rehabilitation practices.