Aquatic vs. Land Locomotor Training Overground Locomotor Training in Improving Ambulatory Function and Health-Related Quality of Life

Study Overview
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Brief Summary
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The aim of this study is to define and evaluate the efficacy of Aquatic Locomotor Training (ALT) compared to overground Locomotor Training in improving ambulatory function and health-related quality of life. The investigators hypothesize, that Aquatic Locomotor Training is capable of producing outcomes that are as good as, or better than, overground Locomotor Training. Aquatic Locomotor Training may be another tool for therapists to utilize for clinical improvements in function and gait for the Spinal Cord Injury (SCI) population. To determine the efficacy of Aquatic Locomotor Training on improving rehabilitation outcomes among patients with incomplete traumatic cervical Spinal Cord Injury by assessing these parameters: Walking speed and endurance Functional balance and fall risk HRQoL To describe the feasibility of conducting Aquatic Locomotor Training as an Locomotor Training modality for the rehabilitation of patients with incomplete traumatic cervical Spinal Cord Injury.

Official Title
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The Efficacy of Aquatic Locomotor Training Compared to Overground Locomotor Training in Improving Ambulatory Function and Health-Related Quality of Life

Conditions
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Spinal Cord Injury

Intervention / Treatment
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* Other: Aquatic Locomotor Training
* Other: Land Locomotor Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18-65 years Cervical level (C1-C7) SCI of traumatic origin Motor incomplete SCI (ASIA Impairment Scale C or D) Chronic SCI, >12 months Age between 18 to 65 years Functional Status i. Overground ambulator (able to walk at least 10 m with or without an assistive device) ii. Able to demonstrate active movement at/or below L2 myotome iii. Able to demonstrate adequate head control 1. Voluntarily extend head while positioned in harness iv. Tolerance to activity 1. Participant able to tolerate up to 1 hour of standing without experiencing symptoms of orthostatic hypotension g. Range of motion i. PROM values for ankle dorsiflexion 1. Neutral positioning, 0○ ii. PROM values for knee extension 1. Up to -10○ iii. PROM values for hip extension 1. Neutral positioning, 0○ h. Height i. Participant with minimum height of 48 i. Weight i. Participant with minimum weight of (to be determined based on therapist's clinical judgment) ii. Participant with maximum weight of 300 lb j. Participants are able to comply with procedures and follow up k. Participants are medically stable, with no recent (1 month or less) inpatient admission for acute medical or surgical issues l. Participants are legally able to make their own health care decisions Exclusion Criteria: a. Medical Complications i. Fracture 1. Participant with presence of unhealed fracture ii. Physician hold for medical reasons that the Principle Investigator will judge and decide on a case by case basis as a potential safety threat to the participant Wounds a. Allowed if physician cleared i. Excluded wounds likely to be present in areas enclosed with harness, present in areas that require access for facilitation, present in areas of direct weight bearing during LT session b. Wounds allowed must be fully covered with gauze then opsite (waterproof bandage) before Aquatic Locomotor Training Comorbidities a. E.g. poorly controlled diabetes, uncontrolled seizures, etc. Orthostatic hypotension a. Participant demonstrates symptomatic orthostatic hypotension that limits activity Uncontrolled autonomic dysreflexia symptoms a. Episode of uncontrolled autonomic dysreflexia symptoms within the past 1 month iii. Diarrhea iv. Mechanical ventilation v. Pacemakers vi. Central lines vii. Women who are pregnant, confirmed by a urine pregnancy test that will be done on all menstruating, or non-menopausal women viii. History of neurological disease ix. Non English speaking participants will not be targeted b. Currently undergoing, or have received Aquatic Locomotor Training or overground Locomotor Training within four weeks of the study start date (see above in 4d for further details)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Aquatic Locomotor Training<br>Aquatic Locomotor Training is a Locomotor Training technique utilizing an underwater treadmill to help increase a patient's independence and function. Aquatic Locomotor Training may require up to three people to obtain desirable gait kinematics: one at each of the patient's legs, and one at the patient's pelvis; however, typically with ambulatory patients, only one therapist is utilized. Therapists are highly trained, using their legs and feet to provide properly timed underwater cues throughout the gait cycle. | Other: Aquatic Locomotor Training<br> <br> |
| Active Comparator: Land Locomotor Training<br>Locomotor Training encompasses a variety of interventions ranging from BWSTT to overground gait training to robotic-assisted walk training. Overground Locomotor Training, depending upon the technique used, can require up to four people to complete the intervention (one at each participant's leg, one at the participant's trunk and/or pelvis, and one monitoring the computer and/or treadmill). | Other: Land Locomotor Training<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline 10 meter Walk Test at 4 months |  | up to 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 6 Minute Walk Test |  | up to 16 weeks | 
| Berg Balance Scale |  | up to 16 weeks | 
| Health Survey on the Short Form 36 |  | up to 16 weeks | 
| Quality of Life on the SCI QL-23 scale |  | up to 16 weeks |