Locomotor Training in the Pediatric Spinal Cord Injury Population: A Systematic Review of the Literature

Background: The restoration of walking ability in the spinal cord injury (SCI) population is an increasingly important goal in physical therapy. Locomotor training (LT) is often implemented with the aim to restore ambulation. At this point, there are no guidelines for LT in the pediatric SCI population. Objectives: The aim of this review is to further narrow the effects of LT to the pediatric SCI population and develop recommendations for pediatric LT. Methods: A thorough search was performed using the following databases: Scopus, CINAHL, PubMed, and Ovid. Studies were selected based on the following inclusion criteria: pediatric SCI population, articles published within last 10 years, human subjects, and LT. Studies looking at other neurological disorders and subjects who were not previously ambulatory were excluded. Five students and one Faculty Research Advisor from the university's Doctor of Physical Therapy Program evaluated the inclusion criteria, conducted a risk of bias assessment using the Downs and Black checklist, and extracted the results. Results: Six studies were selected for this review. They showed gains in distance, gait speed, walking independence, and participation. There were variations in results when comparing gains in injury level based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Conclusions: Currently there is insufficient evidence to determine the best clinical practice guidelines for rehabilitation using LT within the pediatric SCI population.