The Role of Physical Therapy in Improving Mobility After Spinal Cord Injuries

Abstract

Spinal cord injury (SCI) affects approximately 250,000–500,000 individuals globally each year, with the majority experiencing permanent motor and sensory deficits. Physical therapy (PT) is the cornerstone of SCI rehabilitation, driving functional recovery through neuroplasticity-based mechanisms. This study evaluates three PT protocols: conventional PT, body-weight-supported treadmill training with functional electrical stimulation (BWSTT+FES), and robotic-assisted gait training with FES (RAGT+FES) — in 120 participants with AIS A–D SCI over a 24-week randomized controlled trial. Outcomes included WISCI-II, SCIM III, Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), transcranial magnetic stimulation (TMS), and surface electromyography (sEMG). RAGT+FES produced the greatest WISCI-II improvement (Δ+6.9 points, p < 0.001), SCIM III gain (+22.7 points), and gait speed increase (+0.21 m/s), significantly surpassing both comparators. Corticospinal excitability increases (MEP amplitude: +0.27 mV, p < 0.001) were strongly correlated with functional gains (r = 0.71). Motor-incomplete (AIS C/D) patients showed the greatest absolute improvements. These findings establish technology-augmented PT, particularly RAGT+FES, as the superior modality for SCI locomotor rehabilitation