Restoration of walking function in an individual with chronic complete (AIS A) spinal cord injury

Abstract

OBJECTIVE: The prognosis for further recovery of motor function 2 years after complete spinal cord injury is poor. This case report describes recovery of walking function in an a 33-year old man two years post T7 spinal cord injury American Spinal Injury Association Impairment Scale A following intensive physical therapy and robotic locomotor training. DESIGN: Case report. METHODS: The subject engaged in an intensive clinic-based physical therapy program and research-based robotic locomotor training study over a 7-month period. Physical therapy was initiated 4 months prior to entry into the research study, and targeted trunk control, upper extremity strength, and upright mobility. On initial entry into the robotic locomotor training study the subject's AIS A classification was substantiated. Initial, interim, and follow-up tests of sensation, strength, sitting balance, spasticity, and mobility were performed. RESULTS: Lower extremity motor scores improved from 0/50 to 4/50, bilateral hip flexors increased from grade 0/5 to 2/5, warranting injury re-classification from American Spinal Injury Association Impairment Scale A to C. Intensive physical therapy combined with robotic locomotor training was associated with restoration of short distance walking function with lower extremity braces and a walker. CONCLUSION: To our knowledge, this is the first report of an individual with chronic spinal cord injury American Spinal Injury Association Impairment Scale A improving in over-ground walking ability following intensive physical therapy and robotic locomotor training. The presence of a neurophysiologically discomplete lesion probably permitted training of operational neural pathways and enabled the development of useful voluntary movement.