• Kristan A Leech, Catherine R Kinnaird, Carey L Holleran, Jennifer Kahn, and T George Hornby.
• K.A. Leech, PT, DPT, PhD, Interdepartmental Neuroscience Program, Northwestern University, Chicago, Illinois, and Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois.
• Phys Ther. 2016 Dec 1; 96 (12): 1919-1929.

BackgroundHigh-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.ObjectiveThe purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.DesignA single-day, repeated-measures, pretraining-posttraining study design was used.MethodsNineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.ResultsThe results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.LimitationsMeasures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.ConclusionsHigh-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.© 2016 American Physical Therapy Association.

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