AA

Key Points

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  • PES programs are beneficial in preventing and restoring lower limb muscle atrophy as well as improving stimulated lower limb muscle strength and endurance but the persistence of effects after the PES has ended is not known
  • FES-assisted exercise is beneficial in preventing and restoring lower limb muscle atrophy as well as improving lower limb muscle strength and endurance in motor complete SCI.
  • For patients less than 12 months post-SCI, BWSTT may have similar effects on gait outcomes as overground mobility training of similar intensity
  • Body weight-support gait training strategies can improve gait outcomes in chronic, incomplete SCI, but most body weight-support strategies (overground, treadmill, with FES) are equally effective at improving walking speed. Robotic training was the least effective at improving walking speed.
  • rTMS combined with overground locomotor training may not afford further benefits over overground locomotor training alone.
  • There is limited evidence for the benefits of combining the use of certain pharmacological agents with gait training on ambulation in individuals with SCI.
  • FES-assisted walking can enable walking or enhance walking speed in incomplete SCI or complete (T4-T11) SCI. Regular use of FES in gait training or activities of daily living can lead to improvement in walking even when the stimulator is not in use.
  • BWSTT combined with FES of the common peroneal nerve can lead to an overall enhancement of short-distance functional ambulation.
  • Electrical stimulation is shown to be a more effective form of locomotor training than manual assistance and braces.
  • Stimulation with FES while ambulating on a BWS treadmill can increase SCIM mobility scores.
  • BWSTT combined with FES to the quadriceps and hamstrings muscles can enhance functional ambulation.
  • While an 8 channel neuroprosthesis system is safe and reliable, its use with rehabilitation training showed no statistically significant difference in walking outcomes.
  • An ankle-foot-orthosis can enhance walking function in incomplete SCI patients who have drop-foot
  • RGO can enable slow walking in subjects with thoracic lesions, and not at speeds sufficient for community ambulation. The advantages of RGOs appear largely restricted to the general health, well-being and safety benefits related to practice of standing and the ability to ambulate short-distances in the home or indoor settings.
  • PGOs can enable safe walking and reduce energy expenditure compared to passive bracing in patients with thoracic injuries.
  • There is limited evidence that a combined approach of bracing and FES results in additional benefit to functional ambulation in paraplegic patients with complete SCI.
  • There is limited evidence that whole body vibration improves walking function in incomplete SCI
  • EMG Biofeedback may improve gait outcomes in incomplete SCI.
  • Locomotor training programs are beneficial in improving lower limb muscle strength although in acute SCI similar strength increases may be obtained with conventional rehabilitation.
  • The real benefit of locomotor training on muscle strength may be realized when it is combined with conventional therapy. This should be further explored in acute, incomplete SCI where better functional outcomes may be realized with the combination of therapies.