Petrofsky 2001; USA
Downs & Black = 12
Prospective Controlled Trial
N=10

Population: 10 males; age 22-30 yrs; incomplete, T3-T12 lesion level
Treatment: The control group (n=5) had 2-hour daily conventional physical therapy, including 30 min biofeedback of more affected gluteus medius for 2 months. Experimental treatment (n=5) had same program and used a portable home biofeedback device.
Outcome Measures: Muscle strength (isometric strain gauge transducer) and gait analysis.

• Gains in strength (in quadriceps, gluteus medius and hamstring) were seen for both groups but were greater for the experimental group than controls (p<0.05).
• After 2 months of therapy the reduction in Trendelenburg gait was greater for the experimental group than for the control group (p<0.01) and the experimental group showed almost normal gait.

Wernig et al. 1995; Germany
Downs & Black = 9
Case Control
N=153

Population: 153 males and females; locomotor training group: n=89 (44 chronic, 45 acute); control group: n=64 (24 chronic, 40 acute)
Treatment: Body-weight supported treadmill locomotor training (BWSTT) (Laufband therapy) vs conventional rehabilitation. Specific parameters for each were not described or appeared to vary within and between groups.
Outcome Measures: Manual muscle testing, walking function and neurological examination pre and post training.

• 6 /20 chronic individuals initially “nearly paralysed” gained bilateral muscle strength (↑ manual muscle testing)
• For acute patients, no differences in strength gains between BWSTT and conventional rehab.
• Authors noted that locomotor gains had little correlation with strength gains.

Field-Fote 2001; USA
Downs & Black = 15
Pre-post
N=19

Population: 13 males and 6 females; mean age 31.7 yrs; all subjects were diagnosed as AIS C; >1 yr post-injury.
Treatment: Body weight-supported treadmill walking with peroneal nerve FES of the weaker limb for 1.5 hours, 3X/week, 3 months.
Outcome Measures: Lower extremity motor score (LEMS), Gait outcomes.

• LEMS had median increases of 3 points in both the FES-assisted leg and the non-stimulated leg (p<.005).
• ↑AIS lower limb motor scores in 15 of 19 incomplete SCI (AIS C) (p<.005).

Granat et al. 1993; UK
Downs & Black = 15
Pre-post
N=6

Population: 3 males and 3 females; age 20-40 yrs; all subjects were diagnosed as Frankel C or D; C4-L1 lesion level; 2-18 yrs post-injury.
Treatment: FES-assisted locomotor training to quadriceps, hip abductors, hamstrings, erector spinae, common peroneal nerve, minimum 30 min, 5 days/week.
Outcome Measures: Manual muscle tests, maximum voluntary contraction (MVC), upright motor control, spasticity, balance and gait outcomes.

• ↑ strength (↑ hip flexors and knee extensor manual muscle test, p<0.05).
• ↑ strength as indicated by increased quadriceps torque with MVC (p<0.05).

Jayaraman et al. 2008;
USA
Downs & Black = 14
Pre-Post
N = 5

Population: 5 subjects with chronic SCI, age 21-58, level of injury C4-T4.
Treatment: 45 30-min sessions of locomotor training (LT) with partial BWS spread over 9-11 weeks.
Outcome Measures: Voluntary contractile torque; voluntary activation deficits (using twitch interpolation), muscle cross-sectional area (CSA) using MRI.

• All subjects demonstrated improved ability to generate peak isometric torque, especially in the more involved plantar flexor (PF, +43.9 + 20.0%) and knee extensor (KE,+21.1+12.3%) muscles
• Significant improvements of activation deficit in both KE and PF muscles
• All subjects demonstrated increased muscle CSA ranging from 6.8% –21.8%

Gregory et al. 2007; USA
Downs & Black = 12
Case series
N=3

Population: 3 males; all subjects were diagnosed as AIS D; 17-27 mos post-injury.
Treatment: 12 weeks, 2-3 sessions/week of lower extremity resistance training combined with plyometric training (RPT). Resistance exercises included unilateral leg press, knee extension/flexion, hip extension/flexion and ankle plantar flexion exercises on adjustable load weight machines. Subjects performed 2-3 sets of 6-12 repetitions at an intensity of ~70-85% of predicted 1 RM. Unilateral plyometric jump-training exercises were performed in both limbs on a ballistic jump-training device (ShuttlePro MVP ®). Subjects completed a total of 20 unilateral ground contacts with each limb at a resistance of ~25% of body mass. Upon successful completion of at least 20 ground contacts, resistance was increased in increments of 10 lbs.
Outcome Measures: Maximal cross-sectional area of muscle groups, dynamometry, maximum and self-selected overground gait speed.

• RPT resulted in an improved peak torque production in the knee extensors (KE) and ankle plantar flexors (PF).
• Time to peak tension, decreased from 470.8±82.2 to 312.0±65.7 ms in the PF and from 324.5±35.4 to 254.2±34.5 ms in the KE.
• Average rate of torque development and the absolute amount of torque generated during the initial 220 ms during a maximal voluntary contraction improved; more pronounced improvements in the PF than the KE.
• On average, training resulted in a 14.2±3.8 and 8.3±1.9% increase in max-CSA for the PF and KE, respectively.
• RPT resulted in reductions in activation deficits in both the PF and KE muscle groups. 
• Average 36.1% increase in maximum gait speed and 34.7% increase in self-selected gait speed after training.

Hornby et al. 2005; USA
Downs & Black = 12
Pre-post
N=3

Population: 2 males, 1 female; AIS C; 5 weeks/ 6 weeks/ 18 months post-injury.
Treatment: Therapist and Robotic-assisted, body-weight-supported treadmill training (parameters varied between subjects).
Outcome Measures: Lower extremity motor scores (LEMS), functional mobility outcomes.

• No group statistics
• ↑ AIS lower limb motor scores in 2/3 subjects in acute phase (5 & 6 weeks) which cannot be separated from natural recovery. No changes seen in 3rd person initiated at 18 months.

Wernig et al. 1998; Germany
Downs & Black = 9
Pre-post
N=76

Population: Strength data reported for 25 chronic subjects only
Treatment: Body-weight supported treadmill locomotor training (Laufband therapy). 1-2X/day for 30 minutes, 5 days/week for 8-20 weeks.
Outcome Measures: Voluntary muscle scores and walking function.

• No group statistics. All subjects showed increases in cumulative muscle scores (i.e., 8 muscles summed) indicative of increased strength.