Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone
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DESIGN: Longitudinal prospective case series. OBJECTIVE: To evaluate the impact of early introduction post-spinal cord injury (SCI) of twice-weekly body-weight supported treadmill training (BWSTT) on muscle and bone. SETTING: Centre for Health Promotion and Rehabilitation, McMaster University, Canada. METHODS: Five individuals who had sustained traumatic SCI within 2-6 months participated in the study. Bone mineral densities (BMD) of proximal femur, distal femur, proximal tibia and lumbar spine were measured before and after training, as well as muscle cross-sectional area (CSA), BMD and bone geometry at mid-femur and proximal tibia. Serum osteocalcin and urinary deoxypyridinoline were measured at baseline, and after 24 and 48 sessions of training. RESULTS: All participants experienced increased muscle CSAs, ranging from 3.8 to 56.9%. Reductions in BMD were evident in all participants at almost all lower limb sites after training, ranging in magnitude from -1.2 to -26.7%. Lumbar spine BMD changes ranged from 0.2 to -7.4%. No consistent changes were observed in bone geometry. BWSTT did not alter the expected pattern of change in bone biochemical markers over time. The individual with the greatest improvement in ambulatory ability demonstrated the smallest reduction in lower limb BMD. Conversely, the individual who completed the fewest BWSTT sessions demonstrated the greatest reductions in BMD. CONCLUSIONS: Twice-weekly BWSTT appeared to partially reverse muscle atrophy after SCI, but did not prevent bone loss. Larger, controlled trials should evaluate whether relative preservation of bone loss occurs with regular BWSTT following acute SCI. SPONSORSHIP: Ontario Neurotrauma Foundation.
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