The principles of spinal cord injury clinical trial programs are briefly reviewed as one example of the challenge faced by most human studies of neurologically directed therapeutic interventions, including rehabilitation strategies. Different trial protocols are reviewed, as are inclusion/exclusion criteria for study subjects, the choice of clinical endpoints, and the statistical approaches that might be used in a trial program. Potential factors that might confound the accurate interpretation of trial data are also identified. Regardless of the specific therapeutic target or the rehabilitation strategy to be evaluated, there are many unresolved issues that will have to be answered before specific and effective prescriptions can be delivered.

Harvey LA, Lin CW, Glinsky JV, De Wolf A. The effectiveness of physical interventions for people with spinal cord injuries: a systematic review. Spinal Cord. 2009;47:184-195.
,
The effectiveness of physical interventions for people with spinal cord injuries: a systematic review
,
Spinal Cord.
, vol.
47
(pg.
184
-
195
)
Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials. Brit Med J. 2003;327:1459-1461.
,
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials
,
Brit Med J.
, vol.
327
(pg.
1459
-
1461
)
Lammertse D, Tuszynski MH, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial design. Spinal Cord. 2007;45:232-242.
,
Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial design
,
Spinal Cord.
, vol.
45
(pg.
232
-
242
)
Herrero AJ, Menéndez H, Gil L, et al. Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury. Spinal Cord. 2011;49:554-559.
,
Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury
,
Spinal Cord.
, vol.
49
(pg.
554
-
559
)
Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Rating scales as outcomes measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol. 2007;6:1094-1105.
,
Rating scales as outcomes measures for clinical trials in neurology: problems, solutions, and recommendations
,
Lancet Neurol.
, vol.
6
(pg.
1094
-
1105
)
Dimyan MA, Cohen LG. Neuroplasticity in the context of motor rehabilitation after stroke. Nature Rev Neurol. 2011; 7:76-85.
,
Neuroplasticity in the context of motor rehabilitation after stroke
,
Nature Rev Neurol.
, vol.
7
(pg.
76
-
85
)
Burns AS, Ditunno JF. Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management. Spine 2001; 26:S137-145.
,
Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management
,
Spine
, vol.
26
(pg.
S137
-
145
)
Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190-205.
,
Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials
,
Spinal Cord.
, vol.
45
(pg.
190
-
205
)
Steeves JD, Lammertse D, Curt A, et al. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial outcome measures. Spinal Cord. 2007;45:206-221.
,
Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial outcome measures
,
Spinal Cord.
, vol.
45
(pg.
206
-
221
)
Steeves JD, Kramer JK, Fawcett JW, et al. Extent of spontaneous motor recovery after traumatic cervical sensorimotor complete spinal cord injury. Spinal Cord. 2011;49:257-265.
,
Extent of spontaneous motor recovery after traumatic cervical sensorimotor complete spinal cord injury
,
Spinal Cord.
, vol.
49
(pg.
257
-
265
)
Zariffa J, Kramer JK, Fawcett JW, et al. Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury. Spinal Cord. 2011;49:463-471.
,
Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury
,
Spinal Cord.
, vol.
49
(pg.
463
-
471
)
Wolf SL, Winstein CJ, Miller JP, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. The EXCITE randomized clinical trial. J Am Med Assoc. 2006;296:2095-2104.
,
Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. The EXCITE randomized clinical trial
,
J Am Med Assoc.
, vol.
296
(pg.
2095
-
2104
)
Steeves JD, Lammertse DP, Kramer JLK, et al. New 13 Outcome measures for acute/subacute cervical sensorimotor complete (AIS-A) spinal cord injury during a phase 2 clinical trial. Top Spinal Cord Inj Rehabil. 2012;18(1):1-14.
,
New 13 Outcome measures for acute/subacute cervical sensorimotor complete (AIS-A) spinal cord injury during a phase 2 clinical trial
,
Top Spinal Cord Inj Rehabil.
, vol.
18
(pg.
1
-
14
)
Burkhoff D, Parides M, Borggrefe M, Abraham WT, Kadish A. “Responder analysis” for assessing effectiveness of heart failure therapies based on measures of exercise tolerance. J Card Fail. 2009;15:108-115.
,
“Responder analysis” for assessing effectiveness of heart failure therapies based on measures of exercise tolerance
,
J Card Fail.
, vol.
15
(pg.
108
-
115
)
Tuszynski MH, Steeves JD, Fawcett JW, et al. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial inclusion/exclusion criteria and ethics. Spinal Cord. 2007;45:222-231.
,
Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP Panel: clinical trial inclusion/exclusion criteria and ethics
,
Spinal Cord.
, vol.
45
(pg.
222
-
231
)
This content is only available as a PDF.