Influence of intrinsic factors and rehabilitation strategies on walking ability in patients with spinal cord injury
Keywords:
gait recovery, prognostic factors, rehabilitation training, physiotherapyAbstract
Spinal cord injury (SCI) is a devastating condition that results in damage to the contents in vertebral foramen, which can be caused by traumatic causes or other non-traumatic events. The resulting injury affects sensory and motor function after SCI which minimize the ability of patients to control movement, especially for complex tasks such as walking. Therefore, walking recovery depends on various internal factors and the rehabilitation approaches obtained. This review highlights that critical intrinsic factors that influence walking recovery after SCI. These include age, severity of injury, clinical syndrome, muscle strength, reflex recovery, sensory restoration, and fear of falling, all of which are associated with walking recovery in individuals with SCI. Conversely, sex and spasticity have shown inconsistent results, and their impact remains unclear. Moreover, the etiology of the injury does not appear to significantly influence gait recovery. Additionally, rehabilitation strategies play a crucial role in enhancing functional outcomes. This article recommends that physicians and physical therapists should individually plan rehabilitation programs according to the patient’s ability, emphasizing task-specific gait training. However, if whole-gait training is too difficult for patients, this review recommends decomposing the task into smaller sub-tasks (part-task practice). Each component should be practiced until the patients achieve mastery in those sub-tasks before being progressively integrated into the full movement sequence through whole-task practice, thereby facilitating the acquisition of complex motor skills. In addition, rehabilitation gait training should be variability and closely related to real-life situations at home and in their communities. Therefore, this review article provides evidence-based information for healthcare professionals, particularly physicians and physical therapists, in making clinical decisions regarding prognosis, length of stay, and the selection of appropriate rehabilitation techniques for relevant health profession.
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