Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study

Abstract

Background: Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).

Methods: This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). The primary outcome was change in the Functional Independence Measure scores (FIM_gain).

Results: During an inpatient rehabilitation course, participants in the experimental group (n = 11), achieved a mean (SD) FIM_gain of 48 (11) points. For the historical control group (n = 11), participants achieved a mean (SD) FIM_gain of 36 (12) points. From admission to discharge, both groups demonstrated a statistically significant FIM_gain. Between groups analysis revealed no significant difference in FIM_gain (p = 0.022; 95% CI 2.0-22) after a post hoc correction for multiple comparisons. In a secondary subscore analysis, the experimental group achieved significantly higher gains in sphincter control (p = 0.011: 95% CI 0.83-5.72) with a large effect size (Cohen's d 1.19). Locomotion subscores were not significantly different (p = 0.026; 95% CI 0.37-5.3) nor were the remaining subscores in self-care, mobility, cognition, and social cognition.

Conclusions: This is the first study to explore the impact of overground therapy with DBWS on inpatient rehabilitation outcomes for persons with NT-SCI. Overground therapy with DBWS appears to significantly improve functional gains in sphincter control compared to the standard-of-care. Gains achieved in locomotion, mobility, cognition, and social cognition did not meet significance. Findings from the present study will benefit from future large prospective and randomized studies.

Keywords: Functional independence measure; Locomotion; Neuroplasticity; Therapeutic technology.