Journal of neurologic physical therapy: JNPT (J Neurol Phys Ther)

Publications in this journal

• Article: Short-term Maximal-Intensity Resistance Training Increases Volitional Function and Strength in Chronic Incomplete Spinal Cord Injury: A Pilot Study.

  Arun Jayaraman, Christopher K Thompson, William Z Rymer, T George Hornby
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  ABSTRACT: BACKGROUND AND PURPOSE:: Recent research shows that individuals with an incomplete spinal cord injury (SCI) have a reserve of force-generating capability that is observable during repeated intermittent maximal volitional effort contractions. Previous studies suggest that increased neural drive contributes to the enhanced short-term force-generating capabilities. Whether this reserve can be harnessed with repeated training is unclear. The purpose of this pilot study was to investigate the effects of 4 weeks of maximal-intensity resistance training, compared with conventional progressive resistance training, on lower extremity function and strength in chronic incomplete SCI. METHODS:: Using a randomized crossover design, 5 individuals with chronic (>1 year postinjury) SCI American Spinal Injury Association Impairment Scale classification C or D were tested before and after 4 weeks of both maximal-intensity training and progressive resistance training paradigms. Outcomes measures included the 6-Minute Walk Test, the Berg Balance Scale, and peak isometric torque for strength of lower extremity muscles. RESULTS:: Maximal-intensity resistance training was associated with an average increase of 12.19 ± 8.29 m on the 6-Minute Walk Test, 4 ± 1.9 points on the Berg Balance Scale, 4 ± 4.5 points on the lower extremity motor score), while no changes on the above scores were seen with conventional training. Furthermore, significant increases in peak volitional isometric torques (mean increase = 20 ± 8 Nm) were observed following maximal-intensity resistance training when compared with conventional training (mean increase = 0.12 ± 3 Nm, P = 0.03). DISCUSSION AND CONCLUSIONS:: Maximal-intensity training paradigm may facilitate rapid gains in volitional function and strength in persons with chronic motor-incomplete SCI, using a simple short-term training paradigm. VIDEO: Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A37) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 05/2013;
• Article: Combining Self-help and Professional Help to Minimize Barriers to Physical Activity in Persons With Multiple Sclerosis: A Trial of the "Blue Prescription" Approach in New Zealand.

  Hilda Mulligan, Gareth J Treharne, Leigh A Hale, Cath Smith
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  ABSTRACT: BACKGROUND AND PURPOSE:: Increasing participation in physical activity is a goal for many providers working with persons with disability. In order to reduce the many physical and social barriers to participation, there is a need to develop approaches that integrate self-help with professional help for autonomous yet supported health promotion. This study reports on an innovative program, entitled the "Blue Prescription approach", in which physical therapists work collaboratively with persons with a disability to promote community-based physical activity participation. METHOD:: We trialed this collaborative approach with two physical therapists and 27 participants with multiple sclerosis (MS) over a three month period. We gathered qualitative data from four sources: (i) individual interviews with our participants, (ii) individual interviews with the physical therapists, (iii) clinical notes, and (iv) Advisory Group meeting notes and analyzed these for categories to inform the content and resources required for delivery of the approach. RESULTS:: For most participants, the Blue Prescription approach facilitated regular engagement in physical activity of their choice. The Advisory Group provided advice to help solve individual contexts that presented as challenges to participants. Based on review of interview transcripts, we identified four strategies or issues to inform the further development of Blue Prescription. DISCUSSION AND CONCLUSION: Evidence indicated that the Blue Prescription approach can provide a collaborative and flexible way for physical therapists to work with individuals with MS. To further develop the approach, there is a need to address issues related to the use of standardized measures and develop strategies to train physical therapists in collaborative approaches for promotion of physical activity.The integration of self-help and professional help provided by the Blue Prescription approach appeared to result in successful promotion of physical activity in persons with MS. Additional testing is required to examine its efficacy in other health care systems, in conditions beyond MS, and in terms of its economic impact. VIDEO ABSTRACT AVAILABLE: (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A46) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 05/2013;
• Article: Advocacy: Why Now?

  Deborah S Larsen
  Journal of neurologic physical therapy: JNPT 05/2013;
• Article: Physical Activity Behavior Change in Persons With Neurologic Disorders: Overview and Examples From Parkinson Disease and Multiple Sclerosis.

  Terry Ellis, Robert W Motl
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  ABSTRACT: : Persons with chronic progressive neurologic diseases such as Parkinson disease (PD) and multiple sclerosis (MS) face significant declines in mobility and activities of daily living, resulting in a loss of independence and compromised health-related quality of life over the course of the disease. Such undesirable outcomes can be attenuated through participation in exercise and physical activity, yet there is profound and prevalent physical inactivity in persons with PD and MS that may initiate a cycle of deconditioning and worsening of disease consequences, independent of latent disease processes. This Special Interest article highlights the accruing evidence revealing the largely sedentary behaviors common among persons living with physically disabling conditions and summarizes the evidence on the benefits of physical activity in persons with PD and MS. We then examine the social cognitive theory as an approach to identifying the primary active ingredients for behavioral change and, hence, the targets of interventions for increasing physical activity levels. The design and efficacies of interventions based on the social cognitive theory for increasing physical activity in persons with PD and MS are discussed. Finally, a rationale for adopting a secondary prevention approach to delivering physical therapy services is presented, with an emphasis on the integration of physical activity behavior change interventions into the care of persons with chronic, progressive disabilities over the course of the disease. VIDEO ABSTRACT AVAILABLE: (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A42) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 04/2013;
• Article: Aerobic Exercise to Improve Executive Function in Parkinson Disease: A Case Series.

  Rachel Tabak, Gwendolyne Aquije, Beth E Fisher
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  ABSTRACT: BACKGROUND AND PURPOSE:: Parkinson disease (PD) affects cognition, specifically executive function. In people with PD, impaired executive function has been identified as an indicator of fall risk and decreased quality of life. Therefore, it is important to consider impaired executive function in the physical therapy management of PD. It has been established that exercise improves cognition in older adults and emerging evidence suggests a similar effect in people with neurological conditions. We assessed changes in executive function in an aerobic exercise intervention in 2 people with cognitive impairments due to PD. CASE DESCRIPTION:: Two individuals with PD participated in this case series. Participant 1 was a 61-year-old woman with PD dementia, who had PD for 14 years. Participant 2 was a 72-year-old man with mild cognitive impairments, who had PD for 7 years. INTERVENTION:: The participants completed an 8-week program of aerobic exercise training on a stationary bicycle. Primary outcome measures examined executive function, and secondary measures examined disease severity, quality of life, and walking function. OUTCOMES:: Both participants demonstrated improvements in all measures of executive function and quality of life. Participant 1 also made improvements in walking function. DISCUSSION:: Our outcomes provide preliminary evidence of improved executive function following aerobic exercise in people with PD with cognitive impairments. Larger studies are needed to confirm these findings and investigate whether a causal relationship exists between exercise and improved executive function in persons with PD, and how these impact motor performance and quality of life measures. VIDEO ABSTRACT AVAILABLE: (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A43) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 04/2013;
• Article: Tolerance of a standing tilt table protocol by patients an inpatient stroke unit setting: a pilot study.

  Mathew J Baltz, Hendrika L Lietz, Ida Trott Sausser, Claire Kalpakjian, Devin Brown
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  ABSTRACT: : To describe and examine physiologic and self-reported indices of tolerance to a standing tilt table protocol (STTP) among patients following an acute stroke. : We undertook a prospective, observational pilot study of patients admitted to a stroke unit of a single academic medical center. A clinical protocol for the use of the tilt table was developed and applied to subjects in the acute phase following a stroke. The protocol involved a stepwise process to gradually raise the subject into a standing position on the tilt table platform, at 10° intervals from 60° to 90°. Tolerance of the STTP was operationally defined as the ability to sustain 60° or greater of tilt table inclination for a minimum of 5 minutes, without signs or symptoms of intolerance. Specific measures recorded were frequencies of the highest angle achieved, the duration of standing time tolerated, and physiologic response. : Thirty-six patients with ischemic or hemorrhagic stroke (22 women and 14 men) aged 24 to 87 (mean age = 62, SD = 16) years participated in a single trial of the STTP. Fifty-three percent of subjects (N = 19) attained 60° or higher on the tilt table, with a mean total standing time of approximately 9 minutes. : This pilot study suggests that the use of a tilt table is well tolerated among patients in the acute stroke phase and may be an effective tool for introducing early upright mobilization to a medically fragile patient population.Video Abstract available (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A35) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 03/2013; 37(1):9-13.
• Article: Utilization of Aerobic Exercise in Adult Neurological Rehabilitation by Physical Therapists in Canada.

  Lindsay Doyle, Marilyn Mackay-Lyons
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  ABSTRACT: BACKGROUND AND PURPOSE:: Although aerobic exercise (AE) has been shown to improve aerobic capacity and reduce morbidity in neurological populations, its application is challenging. The purpose of this study was to survey Canadian physical therapists practicing in adult neurorehabilitation regarding the use of AE in clinical practice. METHODS:: Members of the Neurosciences Division of the Canadian Physiotherapy Association were invited to participate in a Web-based survey. RESULTS:: Response rate was 36% (N = 155) with every Canadian province represented. The majority of respondents were females in full-time practice for more than 15 years. The majority (88%) agreed/strongly agreed with the following: "AE should be incorporated into treatment programs of patients with neurological conditions." Although 77% prescribed AE, barriers to use included patient concerns (cardiac status, cognitive/perceptual deficits, fatigue) and operations (lack of staff, time, screening tools). The most commonly used screening tools were health records and patient responses to exercise and the least common was exercise stress tests. Overground walking and cycle ergometry were the most frequently used AE modes, and general response to exercise and patient feedback were most frequently used for determining exercise intensity and monitoring AE. DISCUSSION AND CONCLUSIONS:: Respondents clearly recognized the importance of AE in neurorehabilitation. Barriers to application of AE and limitations in the use of appropriate screening and training procedures need to be addressed to advance clinical utilization of AE in neurological practice. Understanding current patterns of utilization of AE is important for the development of professional education initiatives and clinical guidelines for best practices in AE for neurological populations. Video Abstract available (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A40) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 02/2013;
• Article: Test-Retest Reliability and Construct Validity of the Tinetti Performance-Oriented Mobility Assessment in People With Stroke.

  Jennifer Canbek, George Fulk, Leah Nof, John Echternach
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  ABSTRACT: BACKGROUND AND PURPOSE:: The Tinetti Performance-Oriented Mobility Assessment (POMA) is commonly used to measure balance ability in older adults. The purpose of this study was to determine the test-retest reliability and minimal detectable change (MDC) of the POMA and explore its cross-sectional and longitudinal construct validity for use in people early after stroke. METHODS:: Participants were recruited if they had a first documented stroke and were receiving physical therapy during inpatient rehabilitation. The POMA, gait speed, and motor Functional Independence Measure (FIM) scores were collected at admission and at discharge from inpatient rehabilitation. A second trial of the POMA was conducted 1 day after the first trial for reliability analysis. Correlations (Spearman ρ) between raw scores of admission and discharge outcome measures, as well as change in scores between admission and discharge, were used to explore the construct validity of the POMA. RESULTS:: Fifty-five people, with average age of 75 ± 11 years, who had experienced first documented stroke participated in the study and began inpatient physical therapy at a mean of 8 ± 5 days poststroke. Test-retest reliability intraclass correlation coefficient (ICC2,1) was 0.84 and MDC was 6 points. The POMA scores were moderately correlated to motor FIM and gait speed scores at admission (rs = 0.55 and 0.70) and discharge (rs = 0.55 and 0.82.) Change scores of all 3 measures had a fair correlation (rs = 0.28-0.51). DISCUSSION AND CONCLUSIONS:: Test-retest reliability and MDC of the POMA in people with stroke is similar to previous research in older adult long-term care residents. Results support cross-sectional and longitudinal construct validity of the POMA in persons early after stroke and demonstrate validity and reliability to measure balance ability in this population. VIDEO ABSTRACT AVAILABLE: (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A39) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 02/2013;
• Article: Four Square Step Test Performance in People With Parkinson Disease.

  Ryan P Duncan, Gammon M Earhart
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  ABSTRACT: BACKGROUND AND PURPOSE:: The Four Square Step Test (4SST), a quick and simple test of multidirectional stepping, may be useful in predicting falls in people with Parkinson disease (PD). We studied the reliability of the 4SST and its ability to discriminate between freezers and nonfreezers, between fallers and nonfallers, and factors predictive of 4SST performance in people with PD. METHODS:: Fifty-three individuals with idiopathic PD completed the full protocol, including the 4SST as well as measures of balance, walking, and disease severity on anti-PD medication. RESULTS:: Interrater (intraclass correlation coefficient [ICC] = 0.99) and test-retest reliability were high (ICC = 0.78). The median 4SST performance was 9.52 seconds. There was a significant difference between 4SST time on-medication versus off (P = 0.03), while differences between fallers and nonfallers (P = 0.06) and between freezers and nonfreezers (P = 0.08) did not reach significance. All outcome measures were significantly related to 4SST time. In an exploratory, simultaneous regression analysis, 56% of the variance in 4SST performance could be accounted for by 3 measures: Mini-Balance Evaluation Systems Test (Mini-BESTest), Five Time Sit to Stand, and Nine Hole Peg Test. The 4SST cutoff score for distinguishing fallers from nonfallers was 9.68 seconds (Area under curve = 0.65, sensitivity = 0.73, specificity = 0.57). The posttest probability of an individual with a score greater than the cutoff being a faller was 31% (pretest probability = 21%). DISCUSSION AND CONCLUSION:: The 4SST is a reliable, quick test that can distinguish between on-and off-medication conditions in PD but is not as good as other tests (eg, Mini-BESTest) for distinguishing between fallers and nonfallers.Video abstract available (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A31) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 01/2013;
• Article: Dual-Task Training for Balance and Mobility in a Person With Severe Traumatic Brain Injury: A Case Study.

  Nora E Fritz, D Michele Basso
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  ABSTRACT: BACKGROUND AND PURPOSE:: Attentional impairments following severe traumatic brain injury (TBI) are common and can lead to decreased functional mobility and balance, as well as deficits in previously automatic movements such as walking and stair climbing. The purpose of this case study was to determine the feasibility and potential value of incorporating a cognitive-motor dual-task training program into physical therapy for a patient with a severe TBI. CASE DESCRIPTION:: The patient was a 26-year-old woman who sustained a severe TBI during a motor vehicle accident 46 days prior to physical therapy evaluation. On the 8-level Rancho Los Amigos Cognitive Function Scale, her functioning was classified as level IV. She had impairments in attention, functional mobility, and balance, all of which limited her ability to participate in activities of daily living. INTERVENTION:: Physical therapy was provided over 26 days within the inpatient rehabilitation setting. Interventions included mobility tasks such as walking, balancing, and stair climbing. Mobility training was paired with specific secondary cognitive and motor tasks. OUTCOMES:: Dual-task training may have contributed to improvements on outcome measures designed to test divided attention including the Walking While Talking Test and Trail Making Test and a greater rate of improvement in walking speed and time to descend stairs when compared to the baseline phase. DISCUSSION:: Addition of cognitive-motor dual-task training to standard physical therapy in the inpatient rehabilitation setting appears to be feasible and may have value for improving function in individuals with severe TBI. VIDEO ABSTRACT AVAILABLE: (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A41) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 01/2013;
• Article: An Impact Factor for JNPT!

  Edelle Edee Field-Fote
  Journal of neurologic physical therapy: JNPT 12/2012; 36(4):157-8.
• Article: Aerobic Exercise in Subacute Stroke Improves Cardiovascular Health and Physical Performance.

  Sandra A Billinger, Anna E Mattlage, Abigail L Ashenden, Angela A Lentz, Gabe Harter, Michael A Rippee
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  ABSTRACT: BACKGROUND AND PURPOSE:: Cardiovascular health is often impaired after stroke. Reduced exercise capacity (VO2peak) and changes in the vascular system in the stroke-affected limb may impact performance of physical activities such as walking. There is little information regarding the role of prescribed moderate- to high-intensity exercise in subacute stroke. The purpose of this study was to examine whether an 8-week aerobic exercise intervention would improve cardiovascular health and physical performance in participants with subacute stroke. METHODS:: Ten subjects were enrolled in the study and 9 of them completed the intervention. Participants were aged 61.2 ± 4.7 years old, were 66.7 ± 41.5 days poststroke, and had minor motor performance deficits (Fugl-Meyer score, 100.3 ± 29.3). Outcome measures were taken at baseline, postintervention, and at 1-month follow-up. Brachial artery vasomotor reactivity (flow-mediated dilation [FMD]) of both arms was used to assess vascular health, and a peak exercise test was used to assess exercise capacity. The 6-minute walk test (6MWT) was used to assess physical performance. Participants exercised on a recumbent stepper 3 times per week for 8 weeks at a prescribed heart rate intensity. RESULTS:: At baseline, we report between-limb differences in brachial artery FMD and low VO2peak values. After the intervention, significant improvements were reported in the FMD in both arms, resting systolic blood pressure, and the 6MWT. Although we also observed improvements in the resting diastolic blood pressure, heart rate, and VO2peak values, these changes were not significantly different. DISCUSSION AND CONCLUSION:: Aerobic exercise in participants with subacute stroke was beneficial for improving cardiovascular health, reducing cardiac risk, and improving physical performance (6MWT). Video abstract available (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A29) for more insights from the authors.
  Journal of neurologic physical therapy: JNPT 10/2012;
• Article: Deficits in Intersegmental Trunk Coordination During Walking Are Related to Clinical Balance and Gait Function in Chronic Stroke.

  Revital R Hacmon, Tal Krasovsky, Anouk Lamontagne, Mindy F Levin
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  ABSTRACT: BACKGROUND AND PURPOSE:: Decreased walking speed after stroke may be related to changes in temporal and distance gait factors, endurance, and balance. Functional gait deficits may also be related to changes in coordination, specifically between transverse (yaw) plane trunk movements. Our aim was to determine the relationship between intersegmental coordination during gait and functional gait and balance deficits in individuals with stroke. METHODS:: Eleven individuals with chronic stroke and 11 age-matched subjects without disability participated in 2 sessions. In Session 1, clinical evaluations of trunk/limb impairment (Chedoke-McMaster Stroke Assessment), functional gait (Functional Gait Assessment), and balance (BesTest) were performed. In Session 2, gait kinematics during eight 30-second walking trials on a self-paced treadmill at 2 speeds (comfortable and equivalent) were recorded. Equivalence of walking speeds was obtained by asking subjects without disability to walk approximately 20% slower and subjects with stroke to walk approximately 20% faster than their comfortable speed. Thorax and pelvis 3-dimensional angular ranges of motion (ROMs) and intersegmental coordination using the continuous relative phase were analyzed. RESULTS:: Comfortable walking speed was slower in subjects with stroke (0.78 m/s) than in subjects without disability (1.22 m/s), despite matched cadences. At both comfortable and equivalent walking speeds (0.97-0.98 m/s), participants with stroke used more thoracic ROM than pelvic transverse ROM in comparison with subjects without disability. Transverse thorax-pelvis coordination was similar between groups when walking speeds were equivalent, but there was more in-phase coordination in participants with stroke walking at their comfortable, slower speed. In subjects with stroke, thoracic ROM and continuous relative phase were correlated with several clinical functional gait and balance measures. DISCUSSION AND CONCLUSION:: Changes in segmental transverse ROM and coordination were associated with poor gait and with balance abilities in individuals with stroke. Interventions focusing on recovery of these movement characteristics may lead to better clinical outcomes.
  Journal of neurologic physical therapy: JNPT 10/2012;
• Article: President's Perspective: Health Care Reform and Neurologic Physical Therapy.

  Deborah S Larsen
  Journal of neurologic physical therapy: JNPT 10/2012;
• Article: Robot-aided gait training in an individual with chronic spinal cord injury: a case study.

  Lauri Bishop, Joel Stein, Christopher Kevin Wong
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  ABSTRACT: Traditional physical therapy is beneficial in restoring mobility in individuals who have sustained spinal cord injury (SCI), but residual limitations often persist. Robotic technologies may offer opportunities for further gains. The purpose of this case study was to document the use and practicality of gait training for an individual with chronic, incomplete SCI with asymmetric lower limb motor deficits using a novel robotic knee orthosis (RKO). The participant was a 22-year-old woman who sustained fractures of the odontoid process and C5-C6 vertebrae from a motor vehicle accident resulting in incomplete SCI with asymmetric tetraparesis, right side more severe than left side. She required supervised assistance with gait and balance tasks, minimal assistance to ascend/descend steps using a handrail, and upper extremity assistance for sit-to-stand tasks. The participant underwent 7 one-hour sessions of mobility training, using a novel RKO. Her primary goal was to increase independence and endurance with mobility. Functional measures included the 6-Minute Walk Test, the Berg Balance Scale, the Timed Up & Go Test, and the 10-Meter Walk Test. Outcomes were assessed and recorded at baseline and on completion of 7 hours of training with the device over a 2-week period. No adverse events occurred. The RKO was well received by both the participant and the treating therapist. The participant demonstrated improvements in the 6-Minute Walk Test and Berg Balance Scale after RKO-training intervention. Outcomes suggest that the use of this device during a physical therapy program for an individual with incomplete SCI is practical and this device may be a useful adjunct to standard training.
  Journal of neurologic physical therapy: JNPT 07/2012; 36(3):138-43.
• Article: Relationship between perceived and measured changes in walking after stroke.

  Ada Tang, Janice J Eng, Debbie Rand
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  ABSTRACT: Examining participant-perceived change in walking provides insight into whether changes were meaningful for participants. This study examined the relationships between change scores in standardized walking outcomes and ratings of perceived change following exercise poststroke. Self- and fast-paced gait speed and Six-Minute Walk Test (6MWT) distance were assessed in 22 participants (age 67 ± 10.3 years, 1.8 ± 0.9 years poststroke) before and after a 3-month exercise program. Perceived changes were evaluated using a 15-point Likert scale. Correlation analyses between measured and perceived changes were performed. Subgroups of low and high baseline scores were compared for differences in measured and perceived changes. Six-Minute Walk Test change was correlated with perceived change (ρ = 0.52, P = 0.01), greater 6MWT change was demonstrated among participants who perceived improvement compared to those who did not (difference 34.4 m, 95% CI: 17.2-51.6, P = 0.04). After controlling for measured change, participants with low baseline 6MWT distances perceived less change than those who walked high distances at baseline (P = 0.006) even when relative change was equivalent. A global rating scale using meaningful and context-specific questions was used to determine the relationship between measured and participant-perceived changes in 6MWT distance. A meaningful difference in 6MWT change was observed between participants who did and those who did not perceive improvement. Individuals with lower baseline scores may require larger changes in walking distance to perceive that a change has occurred. This study contributes to a growing body of evidence about the relationships between perceived and measured changes in function and is a step in determining thresholds for perceived change in walking after stroke.
  Journal of neurologic physical therapy: JNPT 07/2012; 36(3):115-21.
• Article: Measuring up to our full potential: physical therapy at the EDGE of best clinical practice.

  Edelle Edee Field-Fote
  Journal of neurologic physical therapy: JNPT 07/2012; 36(3):113-4.
• Article: Life care planning projections for individuals with motor incomplete spinal cord injury before and after locomotor training intervention: a case series.

  Sarah A Morrison, Jamie L Pomeranz, Nami Yu, Mary Schmidt Read, Sue Ann Sisto, Andrea L Behrman
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  ABSTRACT: We present a retrospective case series of 2 individuals with motor-incomplete spinal cord injury (SCI) to examine differences in lifetime cost estimates before and after participation in an intensive locomotor training (LT) program. Sections of a life care plan (LCP) were used to determine the financial implications associated with equipment, home renovations, and transportation for patients who receive LT. An LCP is a viable method of quantifying outcomes following any therapeutic intervention. The LCP cases analyzed were a 61-year-old woman and a 4½-year-old boy with motor-incomplete SCI and impairments classified by the American Spinal Injury Association Impairment Scale (AIS) as AIS D and AIS C, respectively. Each patient received an intensive outpatient LT program 3 to 5 days per week. The 61-year-old woman received 198 sessions over 57 weeks and the 4½-year-old boy received 76 sessions over 16 weeks. The equipment, home renovation, and transportation costs of an LCP were calculated before and after LT. Prior to the implementation of LT, the 61-year-old woman had estimated lifetime costs between $150,247.00 and $199,654.00. Following LT, the estimated costs decreased to between $2010.00 and $2446.00 (a decrease of $148,237.00 and $197,208.00). Similarly, the 4-year-old boy had estimated lifetime costs for equipment, home renovation, and transportation between $535,050.00 and $771,665.00 prior to LT. However, the estimated costs decreased to between $97,260.00 and $200,047.00 (a decrease of $437,790.00 and $571,618.00) following LT. The lifetime financial costs associated with equipment, home renovations, and transportation following a motor-incomplete SCI were decreased following an intensive LT program for the 2 cases presented in this article. The LCP, including costs of rehabilitation and long-term medical and personal care costs, may be an effective tool to discern cost benefit of rehabilitation interventions.
  Journal of neurologic physical therapy: JNPT 07/2012; 36(3):144-53.