Abstract

BODY-WEIGHT-SUPPORTED TREADMILL TRAINING FOR SPINAL CORD INJURY REHABILITATION: A META-ANALYSIS

Komal Anturkar*, Dewansh Kapse, Tansira Ansari, Manjiri Meshram, Divyani Barokar, Rahul Lichade, Janhavi Sawarkar, Sneha Harde, Dr. Kamlesh J. Wadher

ABSTRACT

Spinal cord injury is a devastating neurological condition, possibly causing partial or total loss of mobility, sensation, and autonomic regulation below the level of the lesion. Spasticity is among the most frequent and refractory issues faced by persons with SCI; it affects up to two- thirds of them. Spasticity causes muscles to become tight, spasms that happen without your control, and trouble moving-all of which may make it hard to do everyday tasks and impede down recovery. The pathophysiology behind SCI is twofold, with an initial primary injury caused by mechanical insult to the spinal cord, followed by a secondary cascade of biochemical events like ischemia, inflammation, oxidative stress, and programmed cell death (apoptosis). These secondary processes further exacerbate neural damage and impair recovery. Physiotherapy is at the core of the multidisciplinary management of SCI. The goals of physiotherapy are essentially focused on the enhancement of motor recovery, the prevention of complications, andimprovement in the overall quality of life. Passive and active mobilization, strengthening exercises, body-weight-supported treadmill training, task-oriented motor learning, and respiratory therapy are among key physiotherapy strategies. Pharmacological treatments, like baclofen and botulinum toxin type A, are often combined with physiotherapy for the management of spasticity. Baclofen is a GABA-B receptor agonist that is administered to decrease muscle overactivity; side effects include drowsiness and weakness, and it must not be stopped suddenly since withdrawal may be problematic. BoNT-A acts locally, blocking acetylcholine release at neuromuscular junctions, reducing spasticity, and improving functional performance when combined with physiotherapy. It has been shown that the combination of pharmacological and physiotherapeutic interventions is more effective in the reduction of spasticity and the improvement of functional independence than physiotherapy alone. Yet, several clinical challenges still exist, such as drug side effects, inconsistent treatment guidelines, and a general lack of large, high-quality RCTs. Future studies should be directed toward combined treatment protocol standardization, emerging approaches like robotic-assisted therapy and yoga-based interventions, and long-term functional outcome assessments. Ultimately, a holistic, personalized, and evidence-based physiotherapy approach, in collaboration with appropriate pharmacological management, offers the best potential for neuroplasticity, restoration of function, and improvement in quality of life in individuals living with spinal cord injury.

Keywords: Neuroplasticity, Motor recovery, Functional independenc, Quality of life, Baclofen, Botulinum toxin type A (Bont-A).