Balance training improves static stability and gait in chronic incomplete spinal cord injury subjects: a pilot study

Background: Walking is considered the most important goal after an incomplete spinal cord injury (SCI). Only recently it has been demonstrated that balance is a key factor of walking recovery, but no data on the efficacy of balance training in supporting walking function in SCI subjects are available. Aim: The object of the study was to determine the efficacy of visual biofeedback task-specific balance training (vBFB) in improving balance performance and gait in SCI subjects compared with conventional over-ground rehabilitation (Rehab). Design: Open-case study with retrospective matched control. Setting: Chronic SCI outpatients and healthy subjects (H). Population: Twelve SCI subjects with ASIA impairment scale grade D-6 in the vBFB group (EXP) and 6 in the Rehab group (CTRL)-and 6 H. Methods: Data from H were used as reference for physiological balance and gait parameters. CTRL and EXP groups underwent 8 weeks of rehabilitation 5 times/week (CTRL group: 60 minutes devoted to Rehab; EXP group: 40 minutes of Rehab plus 20 of vBFB). At baseline (T0), every 10 vBFB sessions (T1-T2-T3), at the end of training (T4) and 1 and 2 months after vBFB was halted, data on the following parameters were collected and compared between groups and training steps: Berg Balance Scale, Walking Index for Spinal Cord Injury, 6-minute walking, 10-meter walk and timed up and go tests, balance performance (assessed with a stabilometric platform), and kinematic spatio-temporal gait parameters (collected using a 2-dimensional motion analysis system). Results: At T4, only the EXP group experienced a significant improvement in balance and gait demonstrated by clinical and instrumental evaluation; the improvement was maintained at follow-up examinations. Further, in the EXP group, the enhancement in balance that existed at T1 preceded the improvement in gait, and significant correlations between the improvements in gait and balance were observed. In comparison with H data, vBFB treatment demonstrated a significant higher level of effectiveness than conventional Rehab. Conclusion: vBFB training is effective in improving balance and gait in chronic SCI subjects. Clinical rehabilitation impact: Inclusion of vBFB in rehabilitation protocols for chronic SCI subjects effects greater improvements in gait than conventional rehabilitation alone.