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Study design: Prospective observational multicenter study. Objectives: Investigation of content, duration and adjustment of physical therapy for the rehabilitation of ambulation in acute spinal cord injury (SCI). Setting: European Multicenter Study of SCI (EMSCI). Methods: Physical therapy interventions during acute in-patient rehabilitation of eighty incomplete SCI patients (AIS B, C, D all lesion levels) were recorded using the SCI – Intervention Classification System. Mobility was documented using the Spinal Cord Independence Measurement (SCIM III), demographics and clinical data were retrieved from the EMSCI database. Results: Overall recovery of locomotor function was categorized into three outcome groups (G1–G3). Of 76 initial wheelchair-using patients, 53.9% remained wheelchair user (G1), 25% regained moderate (G2) and 21.1% good walking (G3) capability. Strength training was the most frequently applied intervention of body function/-structure across all outcome groups (about 30% of all interventions), while interventions focusing on muscle tone and respiration were predominantly applied in wheelchair-dependent patients. Activity-focused interventions of transfer, transition, sitting were trained most intensively in outcome group G1, while walking and swimming were increasingly trained in patients with moderate and good walking outcomes. Physical therapy interventions of assistive and active trainings as well as corresponding training environments changed with the recovery of locomotor function. Conclusions: Physical therapy of locomotor function is targeted to individual patients’ conditions and becomes adjusted to the progress of ambulation. Although the involved clinical sites were not following explicitly standardized rehabilitation programs, common patterns can be discerned which may form the basis of prospective standardized programs.

Treatment of acute spinal cord injury (SCI) comprises two major therapeutic concepts, which aim for either restoration or compensation. Both strategies aim to reach the highest level of quality of life, mainly reflected by independence and participation in social activities. Restoration in this context means to recover sensorimotor function, which has been impaired or abolished by an incomplete spinal cord or cauda equine lesion. Therefore, only in patients with spared sensorimotor axon pathways restorative strategies can be successfully employed. In contrast, compensation means to replace irreversibly lost function through an alternative strategy, e.g., wheelchair mobility will substitute for the mobility achieved through walking. A number of excellent textbooks describe compensatory strategies in SCI rehabilitation in detail. This chapter will focus on therapies to promote recovery of walking function.