Rehabilitation of locomotion after spinal cord injury

Advances in our understanding of the control of locomotion enable us to optimize the rehabilitation of patients with a spinal cord injury (SCI). Based on various animal models, it is generally accepted that central pattern generators (CPG) exists for the rhythmic generation of stepping movements, and that this is also the case in humans. However, in humans supraspinal control is also essential for the performance of locomotion. For regaining locomotor function, incomplete SCI subjects strongly depend on visual input to compensate for proprioceptive deficits and impaired balance. In addition, they require additional attentional capacity to stand, walk and handle their walking aids. These factors might contribute to their higher risk of falling. During the last decade, task-specific functional training performed by physiotherapists, combined with manual or robotic assisted bodyweight supported treadmill training have improved the regaining of ambulatory function in patients with incomplete SCI. At present, there is no difference in effectiveness between these three types of training. In the future, rehabilitation programs should be optimized to maximally exploit spontaneous and induced neural plasticity, leading to improved ambulation. To evaluate the efficacy of rehabilitation programs and of experimental treatments that might be translated from bench to bedside within the next few years, several objective assessments such as the 10 meter walk test and Walking Index for Spinal Cord Injury have been successfully introduced in the field of SCI rehabilitation.