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Objective To determine changes in balance and gait following a task-specific, performance-based training protocol for overground locomotor training (OLT) in individuals with motor-incomplete spinal cord injury (iSCI). Design Convenience sample, prepilot and postpilot study. Setting Human performance research laboratory. Participants Adults (N=15; 12 men and 3 women; mean age [y] ± SD, 41.5±16.9), American Spinal Injury Association Impairment Scale C or D, >6 months post-spinal cord injury. Interventions Two 90-minute OLT sessions per week over 12 to 15 weeks. OLT sessions were built on 3 principles of motor learning: practice variability, task specificity, and progressive overload (movement complexity, resistance, velocity, volume). Training used only voluntary movements without body-weight support, robotics, electrical stimulation, or bracing. Subjects used ambulatory assistive devices as necessary. Main Outcome Measures Berg Balance Scale (BBS), Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) gait parameters, spatiotemporal measures of gait (step length, step width, percent stance, stance:swing ratio) from 7 participants who walked across a pressure-sensitive walkway. Results Fourteen participants completed the OLT protocol and 1 participant completed 15 sessions due to scheduled surgery. The BBS scores showed a mean improvement of 4.53±4.09 (P Conclusion This pilot demonstrated improvements in balance and selected gait characteristics using a task-specific, performance-based OLT for chronic iSCI.

Objective To determine the effects of a novel overground locomotor training program on walking performance in people with chronic cervical motor incomplete spinal cord injury (iSCI). Design Before-after pilot study. Setting Human performance research laboratory. Participants Adults (N=6, age >18y) with chronic cervical iSCI with American Spinal Injury Association Impairment Scale grades C and D. Interventions Overground locomotor training included two 90-minute sessions per week for 12 to 15 weeks. Training sessions alternated between uniplanar and multiplanar stepping patterns. Each session was comprised of 5 segments: joint mobility, volitional muscle activation, task isolation, task integration, and activity rehearsal. Main Outcome Measures Overground walking speed, oxygen consumption ( V ˙ o 2 ), and carbon dioxide production ( V ˙ co 2 ). Results Overground locomotor training increased overground walking speed (.36±.20 vs .51±.24 m/s, P d =.68). Significant decreases in V ˙ o 2 (6.6±1.3 vs 5.7±1.4mL·kg·min, P =.038, d =.67) and V ˙ co 2 (753.1±125.5 vs 670.7±120.3mL/min, P =.036, d =.67) during self-selected constant work rate treadmill walking were also noted after training. Conclusions The overground locomotor training program used in this pilot study is feasible and improved both overground walking speed and walking economy in a small sample of people with chronic cervical iSCI. Future studies are necessary to establish the efficacy of this overground locomotor training program and to differentiate among potential mechanisms contributing to enhanced walking performance in people with iSCI after overground locomotor training.

Resume Objectif Au cours de la derniere decennie, de nombreux pays a travers le monde ont emis des recommandations pour aider les cliniciens dans leur pratique clinique concernant une prise en charge qui soit basee sur des preuves. Le but de cette etude a ete de presenter et de comparer les systemes de recommandations internationales de qualite et les mieux etablis sur des preuves concernant la prise en charge des lombalgies chroniques communes dans le cadre de medecine de premier recours. Methodes Les systemes de recommandations publies ou mis a jour depuis 2002 ont ete selectionnes en recherchant sur les bases de donnees PubMed, CINAHL, EMBASE, sur les bases de donnees des recommandations et sur le web. La qualite de la methodologie des systemes de recommandations a ete evaluee independamment par trois auteurs, a l’aide de l’outil Appraisal of Guidelines for Research and Evaluation (AGREE). Nous avons synthetise les recommandations dans les domaines du diagnostic et du traitement, recommandations s’appuyant sur des preuves fortes, moyennes ou faibles. Resultats Nous avons inclus 13 systemes de recommandations. De maniere generale, leur qualite etait satisfaisante. Les scores les plus eleves concernaient les domaines de la clarte et de la presentation, ainsi que dans celui du sujet et de son etendue ; les plus bas concernaient leur applicabilite. Il existe un fort consensus entre les recommandations, tout particulierement concernant l’arbre diagnostique decisionnel et l’evaluation des facteurs pronostiques. Les recommandations therapeutiques consensuelles concernaient l’information au malade, les traitements physiques, la prise en charge multidisciplinaire et l’association des traitements a visee physique et psychologique. Conclusion En comparaison aux evaluations precedentes, la qualite moyenne des systemes de recommandations ayant pour objet les lombalgies chroniques s’est amelioree. De plus, les recommandations sont de plus en plus concordantes concernant le traitement des lombalgies chroniques, recommandations clairement distinctes de celles emises pour les lombalgies aigues. Neanmoins, il reste necessaire d’ameliorer encore la qualite et d’obtenir de nouvelles preuves dans cette pathologie.