The use of treadmill training to recover locomotor ability in patients with spinal cord injury

Spinal cord injury (SCI) affects over 1000 people a year in the UK and has severe consequences for their independence and quality of life. Treatments to address SCI focus on techniques that aim to restore some degree of walking or locomotor activity. One such technique is treadmill training of SCI patients. This paper reviews the use of treadmill training in the recovery of locomotor ability in patients with SCI. Outcomes from treadmill training are variable; for patients with incomplete SCI (where some degree of connection between the brain and the spinal cord is spared from injury), treadmill training only enabled limited full weight-bearing locomotion. In patients suffering a complete SCI (where communication between the brain and spinal cord is lost), no weight-bearing locomotion at all was achieved with training. However, treadmill training does influence the activity of the leg muscles in the acute patients, observed by recordings made from the muscles (electromyography). The improvements achieved by treadmill training are not significantly different from other tech- niques such as overground training and functional electrical stimulation. The most effective way of restoring locomotion is through com- plete repair; however, regeneration techniques are still being developed. For regeneration to take place, the neurons within the spinal cord that are important in generating rhythmic movements (the central pattern generator (CPG) circuits) still need to be functioning, as these circuits have been shown to decline through long periods of inactivation. Treadmill training has therefore an important role in keeping neurons active until regenerative techniques become viable. Furthermore, in spinalized rats, it has been shown that by com- bining treadmill training with pharmaceutical and electrical stimulation therapies, greater improvements are seen. This suggests that the treatment of spinal cord injury should not be limited to one method. Techniques that repair the damage are the ultimate goal and it is important that patients keep active in order to increase chances of recovery.