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Doing Better But Not Feeling It: Self-efficacy And Ambulation Ability In Incomplete Spinal Cord Injury: 1550 Board #203 June 2, 9: 00 AM - 10: 30 AM.

Self-efficacy reflects a person’s belief in one’s ability to perform a specific behavior now coupled with expectations that the behavior will achieve desired results later. Perceived rather than actual ability may even be a better predictor of future performance. One expectation for rehabilitation is that individuals will be confident in their ability to function and that their beliefs will match the objective facts of performance. However, expectations can change over time as circumstances change. PURPOSE: We wanted to determine how well confidence and physical performance mirrored each other after task-specific performance-based locomotor training (LT) to improve walking individuals with incomplete spinal cord injury (iSCI). METHODS: 4 males with iSCI (24.75±7.80 years, AIS C, injured at C4, C5, or C6 at least 6 months prior to training) completed at least one 15-week round of a novel LT program, comprised of structured exercise and movement drills based on components of the gait cycle. Sessions were conducted for 90 minutes twice a week. Data were obtained from the OPTIMAL Confidence, the Berg Balance (BBS) and the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) scales before and after each 15 weeks of participation. RESULTS: Despite objective and steady improvements in initial and subsequent ambulation abilities on the BBS (3-13 point increase) and SCI-FAI (2-9 point increase), 3 out of 4 participants had less confidence in their movement ability (9-18 point decline) after the first 15 weeks of participation than at the start of the program. Self-confidence trended toward baseline in subsequent 15-week measurement intervals. Post-participation debriefing indicated that subjects believed that: 1) LT was beneficial; 2) participation enlarged their sense of what was possible in the future and what ability level could be rated as “best” performance now; and 3) they would continue LT because they could do even better. CONCLUSION: Subjects appeared to have changed their framework for evaluating confidence in their abilities as their physical status improved. Despite common wisdom that less confidence now might hamper motivation, some individuals with iSCI may be motivated by gaps between their present perceived and actual performance abilities if they believe they can accomplish more in the future.