Journal Club: Clinical Guidelines to Improve Locomotor Function

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Well, with all the overseas medical work and the holiday season, there was so much to talk about on the blog that there have been very few additions of “Journal Club.” So, I thought I’d kick off the new year with a blog highlighting another interesting study. This study is going to be geared to those PT’s who work in the neuro world as it looks at evidence to establish clinical practice guidelines for locomotor function in a myriad of neurological diagnoses including stroke, incomplete spinal cord, and brain injury. So let’s dive in!

The team of researchers gathered randomized control trials of different neuro-intervention studies focused on individuals with acute onset central nervous system injury. They wanted to look at those interventions that best helped the patient return to a healthy walking speed because walking is a critical component for independent function and is often the most affected motor skill affected by CNS injury.

Clinical Practice Guidelines to Improve Locomotor Function in CNS Injury

After compiling all the studies and analyzing all data, the researchers came to several important conclusions. They found that there was strong evidence for walking training at moderate to high intensities to improve gait speed and function. They also found that virtual reality training can help as well. This makes sense given that walking is a very integrated task so the best way to improve that is to challenge it at higher intensities. Interestingly, they found that there was weaker evidence that strength training and or circuit training improved walking speed and distance. They also assessed some evidence on body weight support treadmill training or robotic assisted training, which I will let you read so I don’t spoil the whole article. 🙂

So, what do we take away? In situations of acute CNS injury, the patient needs to begin walking and moderate to high intensities and we need to make sure we can accomplish that safely. It is not wrong to incorporate strength training and circuit training but it does not have the same effect on gait speed and distance as actually training the function and those are two key measures that are important to recover for the sake of patient independence and decreasing fall risk.

Jason

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