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Published on October 18, 2009

New Study Improves Walking In Patients With Spinal Cord Injury

Novel research presented at Neuroscience 2009 annual meeting

The Rehabilitation Institute of Chicago (RIC), the leading physical medicine and rehabilitation hospital in the country, released new research that may improve the ability to walk in patients with spinal cord injury. Research presented at Neuroscience 2009, the 39th annual meeting of the Society for Neuroscience shows that combining a common antidepressant medication with intensive walking training may provide a new approach for recovering walking ability in patients suffering from spinal cord injury. Read more on this research as featured in this article on MSNBC.com.

New Study Improves Walking In Patients With Spinal Cord Injury

Research shows patients who have

received a common antidepressant

medicine with intensive walking therapy

showed greater recovery of their

walking ability.

According to researchers at RIC, patients with partial recovery of voluntary strength after a spinal cord injury who received the common antidepressant medication escitalopram while undergoing intensive walking training showed greater recovery of their walking ability than those receiving a placebo prior to each training session. Escitalopram, a selective serotonin reuptake inhibitor (SSRI), is a commonly prescribed medication for the treatment of depression. SSRIs are thought to relieve these symptoms by blocking the re-absorption of serotonin by certain nerve cells in the brain. Serotonin also has been shown to facilitate normal communication between the brain and the spinal cord, which may be reduced substantially following spinal cord injury.

These results show a stark contrast to the typical school of thought regarding the use of a prescription medication for improving motor function, and suggest that people with spinal cord injury and some residual motor function may benefit from administration of SSRIs when performing intensive walking training,” said Dr. T. George Hornby, PT, PhD, Director of the Neurolocomotion Lab at the Rehabilitation Institute of Chicago. “We are working to apply the promise of this new approach to current patients and will soon begin clinical trials at RIC to determine if intervention earlier in the recovery process may also provide benefits and help patients regain walking ability.

The research included 50 patients with some residual motor function one year removed from their initial spinal cord injury. Patients received up to 24 sessions of intensive walking on a motorized treadmill over the course of eight weeks, in addition to 10 mg of either the SSRI, escitalopram, or placebo agent five hours prior to each training session. Patients received up to 40 percent body weight support and therapist or robotic-assistance as needed to facilitate continuous walking. Results were measured by the fastest possible walking velocity performed, with secondary measures including balance, strength, spastic reflexes, measures of depression and lower limb coordination and muscle activation patterns during treadmill walking.

In general, patients receiving the SSRI treatment in combination with intensive walking training showed a significantly greater improvement in peak treadmill speeds (mean: 1.03 +/- SD: 0.76 m/s), compared to patients receiving SSRI treatment only (0.41 +/- 0.49, p < 0.01). The differences in the groups were primarily due to significantly improved length of stride (p < 0.01) with non-significant differences in cadence (p = .20).

One patient enrolled in the study, 50 year old Lisa Hurst from Evanston, IL, reported experiencing significant progress from escitalopram combined with intensive walking therapy. Lisa’s spinal cord injury stemmed from a spinal infarction in 2003 that lead to temporary paralysis over most of her body and continued impairment once she began to regain movement in her limbs. She joined the RIC study in 2007 to challenge herself to regain more walking ability in her recovery and was part of the group that received SSRI treatment in addition to the walking therapy. Her treatment goal was to track longer distances at faster speeds, and she reports that the therapy she received at RIC helped her gain physical strength and coordinate her arm movements with her leg movements to make walking a more seamless process.

“I was excited about the opportunity and physical challenge of participating in the study, but also worried that the level of exercise might cause a lot of fatigue and wipe me out,” said Lisa. “But I was able to complete the study without getting too tired and by the end really noticed differences in my coordination and walking speed. Before, it was hard for me to walk and do anything else at the same time because I had to concentrate 100 percent on putting one foot in front of another, keeping my balance and moving in the right direction. By the end of the study, friends commented on my improved speed and I was able to more easily walk down the street and look in store windows along the way barely breaking stride.”

For more information about the data presented at Neuroscience 2009 or for general information about RIC, please visit www.ric.org.

About The Rehabilitation Institute of Chicago

The Rehabilitation Institute of Chicago (RIC) is making a difference in the world for people with disabilities. RIC provides world-class care to patients from around the globe for a range of conditions from acute brain and spinal cord injury to chronic arthritis, pain and sports injuries. RIC, founded in 1954, has been designated the "#1 Rehabilitation Hospital in America" by U.S. News & World Report every year since 1991 and attributes its leading standard of care in part to its innovative research and discovery, particularly in the areas of bionic medicine, robotics, neural regeneration, pain care and better outcomes. RIC operates its 165-bed, flagship hospital in downtown Chicago, as well as a network of 30 sites of care located throughout the city and surrounding suburbs that provide additional inpatient care, day rehabilitation and outpatient services. RIC also maintains strategic alliances with leading healthcare providers throughout the state of Illinois and Indiana.