Abstract
Study design
Prospective observational multicenter study.
Objectives
Investigation of content, duration and adjustment of physical therapy for the rehabilitation of ambulation in acute spinal cord injury (SCI).
Setting
European Multicenter Study of SCI (EMSCI).
Methods
Physical therapy interventions during acute in-patient rehabilitation of eighty incomplete SCI patients (AIS B, C, D all lesion levels) were recorded using the SCI – Intervention Classification System. Mobility was documented using the Spinal Cord Independence Measurement (SCIM III), demographics and clinical data were retrieved from the EMSCI database.
Results
Overall recovery of locomotor function was categorized into three outcome groups (G1–G3). Of 76 initial wheelchair-using patients, 53.9% remained wheelchair user (G1), 25% regained moderate (G2) and 21.1% good walking (G3) capability. Strength training was the most frequently applied intervention of body function/-structure across all outcome groups (about 30% of all interventions), while interventions focusing on muscle tone and respiration were predominantly applied in wheelchair-dependent patients. Activity-focused interventions of transfer, transition, sitting were trained most intensively in outcome group G1, while walking and swimming were increasingly trained in patients with moderate and good walking outcomes. Physical therapy interventions of assistive and active trainings as well as corresponding training environments changed with the recovery of locomotor function.
Conclusions
Physical therapy of locomotor function is targeted to individual patients’ conditions and becomes adjusted to the progress of ambulation. Although the involved clinical sites were not following explicitly standardized rehabilitation programs, common patterns can be discerned which may form the basis of prospective standardized programs.
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Acknowledgements
We acknowledge all participating therapists of the Spinal Cord Injury Centers in Zurich, Heidelberg, Murnau, Hessisch-Lichtenau, Toledo, and Barcelona. This study was supported by the Wings for Life Foundation, the European Multicenter Spinal Cord Injury (EMSCI) network and the Clinical Research Priority Program (CRPP) from Neuro-Rehab. We thank Chris Easthope Schmidt for proofreading.
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Martina Franz and Lea Richner contributed equally to this work.
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Franz, M., Richner, L., Wirz, M. et al. Physical therapy is targeted and adjusted over time for the rehabilitation of locomotor function in acute spinal cord injury interventions in physical and sports therapy. Spinal Cord 56, 158–167 (2018). https://doi.org/10.1038/s41393-017-0007-5
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DOI: https://doi.org/10.1038/s41393-017-0007-5
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