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Observational Study
. 2018 Mar;99(3):555-562.
doi: 10.1016/j.apmr.2017.10.003. Epub 2017 Oct 26.

Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury

Sarah A Morrison  1 , Douglas Lorenz  2 , Carol P Eskay  3 , Gail F Forrest  4 , D Michele Basso  5
Affiliations
Observational Study

Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury

Sarah A Morrison et al. Arch Phys Med Rehabil. 2018 Mar.

Abstract

Objective: To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers.

Design: Prospective observational cohort with longitudinal follow-up.

Setting: Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN).

Participants: Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions.

Interventions: Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks.

Main outcome measures: International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy.

Results: Significant 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 to 12 months after treatment.

Conclusions: Delivering 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.

Keywords: Health care costs; Locomotion; Rehabilitation; Spinal cord injuries.

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Comment in

  • Questionable Conclusions About Locomotor Training.
    Stillman M. Stillman M. Arch Phys Med Rehabil. 2018 May;99(5):1024. doi: 10.1016/j.apmr.2017.12.023. Arch Phys Med Rehabil. 2018. PMID: 29699646 No abstract available.
  • Response to Letter to the Editor.
    Morrison SA, Lorenz D, Eskay CP, Forrest GF, Basso DM. Morrison SA, et al. Arch Phys Med Rehabil. 2018 May;99(5):1024-1026. doi: 10.1016/j.apmr.2018.01.003. Arch Phys Med Rehabil. 2018. PMID: 29699647 No abstract available.

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