Durability of Improved Trunk Control Following Activity-Based Locomotor Training in Children with Acquired Spinal Cord Injuries

Background: A recent study in pediatric spinal cord injury (SCI) demonstrated activity-based locomotor training (ABLT) improved trunk control, measured by the Segmental Assessment of Trunk Control (SATCo). It is not known whether improved trunk control is maintained and, if so, for how long. Objectives: The purpose was to determine the durability of improvements in trunk control after ABLT is stopped. We hypothesized that SATCo scores at follow-up would not significantly regress (a) beyond the score measured at discharge and (b) to the initial SATCo pre-ABLT level. Methods: Patients were assessed pre ABLT, after completing an episode of care, and upon returning to the clinic 1 or more months without ABLT. Durability is a score change less than 3, which is the measurement error of the SATCo. Results: Twenty-eight children (10 females; 4 +/- 2.5 years old) completed at least 40 sessions of ABLT and returned for the follow-up 8 +/- 7 months (range, 1-38) after the episode of care. Trunk control improved 6 +/- 3/20 points with ABLT (p < .0001). At the follow-up, average SATCo score decreased 2 +/- 2/20 points, and the follow-up SATCo score was 4 +/- 3 points higher than pre ABLT (p < .0001). There was no correlation between the change in SATCo scores and changes in age, weight, height or elapsed time between discharge and follow-up. Conclusion: Improvements in trunk control due to ABLT were maintained, indicating ABLT is neurotherapeutic. Although not achieving complete recovery of trunk control, the immediate effects and sustained improvements provide support for a clinical shift to neurotherapeutic approaches and for continued research to achieve enhanced recovery.