Background. Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective. The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific versus impairment-based interventions on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI >1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 weeks, with interventions alternated after >4 weeks delay. Both strategies focused on achieving higher cardiovascular intensities, with training specificity manipulated by practicing only stepping practice in variable contexts or practicing tasks targeting impairments underlying locomotor dysfunction (strengthening, balance tasks, and recumbent stepping). Results. Significantly greater increases in fastest overground and treadmill walking speeds were observed following task-specific versus impairment-based training, with moderate associations between differences in amount of practice and outcomes. Gains in balance confidence were also observed following task-specific vs impairment-based training, although incidence of falls was also increased with the former protocol. Limited gains were observed with impairment-based training except for peak power during recumbent stepping tests. Conclusion. The present study reinforces work from other patient populations that the specificity of task practice is a critical determinant of locomotor outcomes and suggest impairment-based exercises may not translate to improvements in functional tasks. Clinical Trial Registration URL. https://clinicaltrials.gov/; Unique Identifier: NCT02115685.

中文翻译：

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针对慢性脊髓损伤患者的运动能力的特定任务训练与基于损伤的训练：随机交叉研究

背景。许多试图改善运动不完全性脊髓损伤 (iSCI) 后运动功能的研究侧重于提供踏步练习。然而，物理治疗策略的观察性研究表明，临床康复期间的踏步练习量是有限的；相反，许多干预措施侧重于减轻步行功能障碍的潜在损害。目标。这项盲法随机试验的目的是评估特定任务与基于损伤的干预措施对 iSCI 患者步行结果的影响。方法。使用交叉设计，持续时间超过 1 年的 iSCI 的非卧床参与者在 ≤ 6 周内进行了多达 20 次基于任务的特定训练（直立踏步）或基于损伤的训练，并在延迟 > 4 周后交替进行干预。这两种策略都专注于实现更高的心血管强度，通过在可变环境中仅练习步进练习或练习针对运动功能障碍潜在损伤的任务（加强、平衡任务和卧式步进）来操纵训练特异性。结果。在特定任务训练与基于损伤的训练之后，观察到最快的地上和跑步机步行速度显着增加，练习量和结果的差异之间存在适度关联。在针对特定任务的训练与基于损伤的训练之后，也观察到平衡信心的增加，尽管前一种方案也增加了跌倒的发生率。除了卧式步进测试期间的峰值功率外，基于损伤的训练观察到的收益有限。结论。本研究强化了其他患者群体的工作，即任务练习的特异性是运动结果的关键决定因素，并表明基于损伤的练习可能不会转化为功能任务的改善。临床试验注册网址。https://clinicaltrials.gov/；唯一标识符：NCT02115685。