Longitudinal recovery and reduced costs after 120 sessions of locomotor training for motor incomplete spinal cord injury

Publication date: Available online 26 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sarah A. Morrison, Douglas Lorenz, Carol P. Eskay, Gail F. Forrest, D. Michele Basso
ObjectiveTo determine the impact of long term, body weight supported locomotor training (BWSLT) after chronic, incomplete spinal cord injury (SCI). Also, health care costs were estimated related to lost recovery potential and preventable secondary complications that may have occurred due to visit limits imposed by insurers.DesignProspective observational cohort with longitudinal follow up.SettingEight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network® (NRN).ParticipantsIndividuals with motor incomplete chronic SCI (Asia Impairment Scale C or D; n=69; 0.1-45 yr after SCI), who completed at least 120 NRN physical therapy sessions.InterventionsManually-assisted locomotor training in a body weight supported treadmill environment, overground standing and stepping activities, and community integration tasks.Main Outcome Measure(s)International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, SCI-FAI, Berg Balance Scale, Modified Functional Reach, 10-meter walk test and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6-12 month follow-up after discharge from therapy.ResultsSignificant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6-12 months after treatment.ConclusionsDelivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20 session insurance limit can reduce rehospitalizations and long term health costs.



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