Every step counts

Standard tests may keep spinal cord patients from getting therapy

By John Pastor

Paralyzed when he was just a baby, Luke Adams has learned to initiate steps with assistance as part of the Kids STEP study.

The traditional way to predict whether children can regain movement after spinal cord injuries may exclude a small subset of patients who could benefit from therapy, according to two studies UF researchers presented at the Society for Neuroscience meeting in November.

In one study, researchers describe details of a child with incomplete spinal cord injury who continues to improve four years after recovering walking ability in a locomotor training program at UF, even though clinical assessment tools predicted he would never walk again.

In another presentation, the scientists discussed findings in which three of six children with severe, chronic and incomplete spinal cord injuries — patients who retain some sensation or movement below the injury — improved through locomotor training, to the point where they could take steps. Even the three who did not regain stepping ability acquired greater trunk control.

The research was part of the Kids Step Study conducted at UF and Brooks Rehabilitation and led by Andrea Behrman, Ph.D., P.T., an associate professor of physical therapy in the College of Public Health and Health Professions, and Dena Howland, Ph.D., an associate professor of neuroscience with the College of Medicine. Both also are affiliated with the McKnight Brain Institute and the Malcom Randall Veterans Affairs Medical Center.

“The prevailing clinical view is patients who are able to recover need to display early leg movement,” Howland said. “The children in our studies displayed minimal or no movement, yet some were still able to make significant improvement.”

One study participant was a 4 ½-year old boy who received a disabling cervical spinal cord injury at the age of 3½. Before he began in the locomotor training program, clinical measures predicted he would not walk again. After locomotor therapy, he now walks independently and has learned to pedal a tricycle, crawl, climb stairs and swim.

“These are all severely injured kids,” Behrman said. “Just think across the lifespan of a child who may be 3 or 6 or 10 years old at the time of injury, what a difference it would make if they could regain a fraction of mobility. Even better trunk control means quite a bit — pushing a wheelchair, or sitting behind a desk more comfortably, can be very important.”

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