Task-Specific Versus Impairment-Based Training on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study.
Jennifer K Lotter, Christopher E Henderson, Abbey Plawecki and 5 others
PMID 32476619WHAT IT FOUND
Task-specific stepping training improved walking speed and endurance more than impairment-based exercises in people with chronic incomplete spinal cord injury.
However, the stepping group experienced significantly more minor adverse events, including falls. Clinicians must weigh these gains against the increased fall risk and educate patients on safety.
Key findings
01Fastest walking speed improved significantly more with task-specific stepping training than with impairment-based training.
02Peak treadmill speed and 6-minute walk distance showed significantly greater improvements following task-specific stepping training compared to impairment-based training.
03Minor adverse events, particularly falls, occurred significantly more often during task-specific training than during impairment-based training.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Small sample size (16 participants) limits generalizability. Unblinded assessment for peak treadmill speed and recumbent stepping power. Potential carry-over effects inherent in the crossover design, although initial parallel-group analyses supported the main findings. Difficulty achieving target intensities during impairment-based balance tasks, potentially biasing results. Accelerometer step counts may have overestimated actual walking practice due to movement during transitions.
Declared interests
The authors declared no conflicts of interest. The study was supported by NIH and other non-PHS government sources.
The easy way to misread this
Do not assume task-specific training is universally safer or better tolerated. It produced significantly more minor adverse events, including falls, compared to impairment-based training. Also, do not expect improvements in all functional domains; balance and lower extremity strength scores did not differ significantly between groups, and impairment-based training was superior for improving recumbent stepping power.