A physical therapist is developing a rehabilitation plan for a patient with C6 AIS D SCI who has voluntary motor function in the lower extremities. Based on locomotor training philosophy, which approach is MOST appropriate?

A physical therapist is developing a rehabilitation plan for a patient with C6 AIS D SCI who has voluntary motor function in the lower extremities. Based on locomotor training philosophy, which approach is MOST appropriate?

• A. Focus exclusively on compensatory wheelchair mobility skills since the patient has tetraplegia
• B. Emphasize recovery-based strategies including weight bearing and locomotor training to promote neuroplasticity below the level of injury
• C. Prescribe bilateral KAFOs and a rolling walker for compensatory gait training
• D. Defer all gait training until the patient demonstrates at least 20/50 on the ASIA lower extremity motor score

Answer: (B)

Locomotor training relies on repetitive, task-specific walking practice with weight-bearing input to elicit neuroplastic changes in the spinal locomotor networks below the level of injury. In a person with a C6 AIS D spinal cord injury, there is preserved motor function below the injury, so the goal is to maximize recovery by actively practicing walking. This means using weight-bearing standing and stepping activities—often starting with body-weight-supported treadmill training or harness-assisted practice—and progressing toward more challenging, overground gait as tolerance allows. By repeatedly engaging the stepping circuitry, the nervous system can reorganize to improve voluntary control, closer to normal gait patterns, while also supporting cardiovascular health, bone density, and overall function. Focusing only on compensatory wheelchair skills misses the opportunity to promote recovery, and relying solely on braces or a rolling walker can limit the potential for neuroplastic changes. Delaying gait training until a specific motor score is reached is unnecessary and may forgo the plasticity window that supports functional improvement.

Locomotor training relies on repetitive, task-specific walking practice with weight-bearing input to elicit neuroplastic changes in the spinal locomotor networks below the level of injury. In a person with a C6 AIS D spinal cord injury, there is preserved motor function below the injury, so the goal is to maximize recovery by actively practicing walking. This means using weight-bearing standing and stepping activities—often starting with body-weight-supported treadmill training or harness-assisted practice—and progressing toward more challenging, overground gait as tolerance allows. By repeatedly engaging the stepping circuitry, the nervous system can reorganize to improve voluntary control, closer to normal gait patterns, while also supporting cardiovascular health, bone density, and overall function.

Focusing only on compensatory wheelchair skills misses the opportunity to promote recovery, and relying solely on braces or a rolling walker can limit the potential for neuroplastic changes. Delaying gait training until a specific motor score is reached is unnecessary and may forgo the plasticity window that supports functional improvement.