Ambulation and Balance Outcomes Measure Different Aspects of Recovery in Individuals With Chronic, Incomplete Spinal Cord Injury

Abstract Forrest GF, Lorenz DJ, Hutchinson K, VanHiel LR, Basso DM, Datta S, Sisto SA, Harkema SJ. Ambulation and balance outcomes measure different aspects of recovery in individuals with chronic, incomplete spinal cord injury. Objective To evaluate relationships among ambulation and balance outcome measures over time for incomplete spinal cord injury (SCI) after locomotor training, in order to facilitate the selection of effective and sensitive rehabilitation outcomes. Design Prospective observational cohort. Setting Outpatient rehabilitation centers (N=7) from the Christopher and Dana Reeve Foundation NeuroRecovery Network. Participants Patients with incomplete SCI (N=182) American Spinal Injury Association Impairment Scale level C (n=61) and D (n=121). Interventions Intensive locomotor training, including step training using body weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Main Outcome Measures Six-minute and 10-meter walk tests, Berg Balance Scale, Modified Functional Reach, and Neuromuscular Recovery Scale collected at enrollment, approximately every 20 sessions, and on discharge. Results Walking and standing balance measures for all participants were strongly correlated ( r ≥.83 for all pairwise outcome correlations), standing and sitting balance measures were not highly correlated ( r ≤.48 for all pairwise outcome correlations), and walking measures were weakly related to sitting balance. The strength of relationships among outcome measures varied with functional status. Correlations among evaluation-to-evaluation changes were markedly reduced from performance correlations. Walk tests, when conducted with different assistive devices, were strongly correlated but had substantial variability in performance. Conclusions These results cumulatively suggest that changes in walking and balance measures reflect different aspects of recovery and are highly influenced by functional status and the utilization of assistive devices. These factors should be carefully considered when assessing clinical progress and designing clinical trials for rehabilitation.