What are the chances of walking after a spinal cord injury?

Incomplete spinal cord injury often results in difficulty walking. Training on a treadmill with body weight support may improve walking ability after spinal cord injury. The purpose of this study is to examine the effect of treadmill speed on spinal cord function and walking performance.

Conventional rehabilitation following spinal cord injury (SCI) emphasizes functional gains through strengthening and compensation, using braces and assistive devices to achieve mobility. Rehabilitation practice using compensatory approaches is based on the prevailing assumption that neural recovery is not possible following SCI.

Recent evidence contradicts this assumption. Stimulated by the proper activation of peripheral afferents associated with walking, neuronal circuits may reorganize by strengthening of existing and previously inactive descending connections and local neural circuits. New approaches to locomotor recovery after SCI utilize sensory information related to locomotion to improve treadmill and overground walking.

Locomotor training velocity may be a critical, task-specific, and activity-dependent parameter affording appropriate phasic, afferent input to the neural system and promoting neural plasticity. The purpose of this study is to evaluate the effects of training velocity in a long-term locomotor training program on both neurophysiological and behavioral plasticity in individuals with incomplete SCI.

Sixteen patients with incomplete SCI will be recruited to participate in this study. Baseline evaluations will include American Spinal Injury Association classification, rate-sensitive depression, phase-dependent H-reflex modulation at self-selected and fast overground walking velocities, and MRI of the spine. Patients will wear a step activity monitor for a 48-hour period, quantifying baseline walking activity level.

All patients will participate in a locomotor training program. Patients will be randomly assigned to either training at self-selected treadmill velocity or at a normal walking velocity. Patients will have 45 training sessions over 9 weeks. Each training session will include 30 minutes of walking. Interim testing of rated depression, spatial-temporal parameters of walking, MRI, and walking activity will occur through the 9-week training period. Post-testing will occur within 2 days of the last training session and at a 1 month after completion of the training. During the month following long-term training, patients will be instructed to return to their self-selected routine activities of daily living.

Inclusion criteria:

• First time spinal cord injury (SCI) from trauma, vascular, or orthopedic pathology at cervical or thoracic levels
• Category C or D SCI as defined by the American Spinal Injury Association (ASIA) Impairment Scale
• 1 to 3 years post-SCI
• Ability to walk independently a minimum of 40 feet with or without an assistive device
• Currently spending a minimum of 30 minutes per day walking
• No change in anti-spasticity medication during the study
• Medically stable
• Participant's personal physician must verify the participant's medical status

Exclusion criteria:

• Bladder infection, decubiti, osteoporosis, cardiopulmonary disease, pain, or other significant medical complications that would prohibit or interfere with training and testing of walking function or alter compliance with a training protocol
• Currently participating in a rehabilitation program or another research protocol that could interfere or influence the outcome measures of the current study
• Congenital SCI (e.g., Chiari malformation, myelomeningocele, intraspinal neoplasm, Frederich's ataxia)
• Other degenerative spinal disorders (e.g., spinocerebellar degeneration, syringomyelia) that may complicate the treatment or evaluation procedures

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

US Department of Veterans Affairs

The qualified answer to this question is yes, a person can walk again after suffering a spinal cord injury. This is possible because the spinal cord is capable of reorganizing itself and making adaptive changes through a process known as neuroplasticity. Individuals who work with knowledgeable and skilled medical personnel will generally be able to promote neuroplasticity as much as possible, so they can again achieve mobility. The chances that you’ll be able to walk again after a spinal cord injury are described below, as are the treatments which would be necessary in order to achieve this kind of mobility.

How likely is it that you can walk again?

The key factor in determining whether or not you can walk again after spinal cord injury, is exactly where the injury occurred to the spinal cord. Generally speaking, the lower on the back that the injury occurred, the less impact it will have on your bodily functions. So for instance, if you suffered a spinal cord injury up in the area around your neck, it might very well leave you paralyzed from that point downward.

In this situation, rather than trying to walk again, you would most likely be focused on recovering functionality with your arms and hands. This would allow you to perform basic daily activities like feeding yourself, dressing, and bathing. On the other hand, if your spinal cord injury occurred low down in the back area, you would have much less loss of functionality and your rehabilitation would probably focus on endurance and strengthening the body. You would be quite likely to regain the ability to walk, although it may be necessary to use supporting devices for some period of time before you can walk unassisted.

Another factor associated with whether or not you can walk again would be the severity of the injury to your spinal cord. Your chances of recovery are much better when you have more spared neural pathways at the site of a spinal cord injury. Spared neural pathways are connections between the brain and those nerves which are undamaged below the level of your injury.

Damaged neurons in the spinal cord are not able to regenerate themselves or to take advantage of neuroplasticity. If your spinal cord injury is classified as a complete injury, that means you will have no spared neural pathways, and no communication between the brain and those nerves. That means anyone suffering a complete spinal cord injury is not as likely to recover mobility as someone who has an incomplete injury.

Treatments that will help you walk again

Obviously, every spinal cord injury is different, and that means every patient will require a completely customized program of treatment, tailored to their circumstances. The starting point for any recovery after a spinal cord injury will be physical therapy, and the more aggressively you apply yourself to physical therapy, the more likely it is you’ll achieve mobility again. You are likely to experience weakness or some level of paralysis as a result of your injury, because the communication between your brain and that area has been disrupted.

In order to regain mobility, you will need to retrain the spinal cord, muscles, and the brain to work together again through specific and repetitive movements. The more you practice these movements, the better developed will become the neural pathways that facilitate navigation. Early on in physical therapy, the focus will be on addressing leg strength, so as to strengthen the leg and avoid the possibility of atrophy from non-usage.

Another treatment in the recovery process is known as locomotor training, and this focuses specifically on learning how to walk again after a spinal cord injury. It may call for the use of parallel bars, walkers, crutches, braces, or even treadmills, so as to provide more stability and reduce joint pressure. This is an effective approach because it emphasizes repetition and it’s task-specific, both of which are important factors in promoting neuroplasticity.

One more treatment option which will help with recovery is electrical stimulation. This involves having an electrode array implanted onto the spinal column, and this sends electrical currents below the level of the injury. In many cases, it’s not possible for the brain to send messages to these areas, and the electrical currents take the place of those brain signals to provide stimulation for muscle movement below the injury level.

Some people who have experienced major spinal cord injuries which have been classified as complete injuries, have still been able to move and walk about again with the help of electrical stimulation. Since electrical stimulation works around the damage to the spinal cord, it is possible to recover even from a complete spinal cord injury. To sum up, it is theoretically possible to recover from any kind of injury to the spinal cord, but the level of recovery will depend on your commitment to treatment, and to the possibility of receiving the most effective forms of treatment.