Walking speed is associated with walking behavior in ambulatory people with a recent spinal cord injury

Background:People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users.Objective:The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension.Study design:Quasi experimental study.Methods:Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate.Results:Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ.Conclusion:Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis.Clinical relevanceIt is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

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Stabilization Strategies for Fast Walking in Challenging Environments With Incomplete Spinal Cord Injury

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.709420 ◽

2021 ◽

Vol 2 ◽

Author(s):

Tara Cornwell ◽

Jane Woodward ◽

Wendy Ochs ◽

Keith E. Gordon

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Walking Speed ◽

Center Of Mass ◽

Lateral Stability ◽

Step Width ◽

Incomplete Spinal Cord Injury ◽

Foot Placement ◽

Fast Speed ◽

Cord Injury

Gait rehabilitation following incomplete spinal cord injury (iSCI) often aims to enhance speed and stability. Concurrently increasing both may be difficult though as certain stabilization strategies will be compromised at faster speeds. To evaluate the interaction between speed and lateral stability, we examined individuals with (n = 12) and without (n = 12) iSCI as they performed straight walking and lateral maneuvers at Preferred and Fast treadmill speeds. To better detect the effects of speed on stability, we challenged lateral stability with a movement amplification force field. The Amplification field, created by a cable-driven robot, applied lateral forces to the pelvis that were proportional to the real-time lateral center of mass (COM) velocity. While we expected individuals to maintain stability during straight walking at the Fast speed in normal conditions, we hypothesized that both groups would be less stable in the Amplification field at the Fast speed compared to the Preferred. However, we found no effects of speed or the interaction between speed and field on straight-walking stability [Lyapunov exponent or lateral margin of stability (MOS)]. Across all trials at the Fast speed compared to the Preferred, there was greater step width variability (p = 0.031) and a stronger correlation between lateral COM state at midstance and the subsequent lateral foot placement. These observations suggest that increased stepping variability at faster speeds may be beneficial for COM control. We hypothesized that during lateral maneuvers in the Amplification field, MOS on the Initiation and Termination steps would be smaller at the Fast speed than at the Preferred. We found no effect of speed on the Initiation step MOS within either field (p > 0.350) or group (p > 0.200). The Termination step MOS decreased at the Fast speed within the group without iSCI (p < 0.001), indicating a trade-off between lateral stability and forward walking speed. Unexpectedly, participants took more steps and time to complete maneuvers at the Fast treadmill speed in the Amplification field. This strategy prioritizing stability over speed was especially evident in the group with iSCI. Overall, individuals with iSCI were able to maintain lateral stability when walking fast in balance-challenging conditions but may have employed more cautious maneuver strategies.

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A User Interface System with See-Through Display for WalkON Suit: A Powered Exoskeleton for Complete Paraplegics

Applied Sciences ◽

10.3390/app8112287 ◽

2018 ◽

Vol 8 (11) ◽

pp. 2287 ◽

Cited By ~ 1

Author(s):

Hyunjin Choi ◽

Byeonghun Na ◽

Jangmok Lee ◽

Kyoungchul Kong

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

User Interface ◽

Walking Speed ◽

Ground Contact ◽

Motion Modes ◽

Cord Injury ◽

Interface System ◽

Powered Exoskeleton ◽

Complete Spinal Cord Injury

In the development of powered exoskeletons for paraplegics due to complete spinal cord injury, a convenient and reliable user-interface (UI) is one of the mandatory requirements. In most of such robots, a user (i.e., the complete paraplegic wearing a powered exoskeleton) may not be able to avoid using crutches for safety reasons. As both the sensory and motor functions of the paralyzed legs are impaired, the users should frequently check the feet positions to ensure the proper ground contact. Therefore, the UI of powered exoskeletons should be designed such that it is easy to be controlled while using crutches and to monitor the operation state without any obstruction of sight. In this paper, a UI system of the WalkON Suit, a powered exoskeleton for complete paraplegics, is introduced. The proposed UI system consists of see-through display (STD) glasses and a display and tact switches installed on a crutch for the user to control motion modes and the walking speed. Moreover, the user can monitor the operation state using the STD glasses, which enables the head to be positioned up. The proposed UI system is verified by experimental results in this paper. The proposed UI system was applied to the WalkON Suit for the torch relay of the 2018 Pyeongchang Paralympics.

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The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: A pilot study

Prosthetics and Orthotics International ◽

10.1177/0309364614531010 ◽

2014 ◽

Vol 39 (4) ◽

pp. 286-292 ◽

Cited By ~ 4

Author(s):

Mokhtar Arazpour ◽

Masoud Gharib ◽

Stephen William Hutchins ◽

Monireh Ahmadi Bani ◽

Sarah Curran ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Walking Speed ◽

Step Length ◽

Trunk Flexion ◽

Gait Parameters ◽

Cord Injury ◽

Before And After ◽

Spatial Parameters ◽

Trunk Extension

Background:Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users.Objectives:To investigate the effect on kinematics and temporal–spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension.Study design:Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses.Methods:Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal–spatial parameters and lower limb kinematics were analyzed.Results:Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation.Conclusion:Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk.Clinical relevanceDonning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.

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Assessment of Walking Speed and Distance in Subjects With an Incomplete Spinal Cord Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968306297861 ◽

2007 ◽

Vol 21 (4) ◽

pp. 295-301 ◽

Cited By ~ 62

Author(s):

Hubertus J. A. van Hedel ◽

Volker Dietz ◽

Armin Curt

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Walking Speed ◽

Incomplete Spinal Cord Injury ◽

Cord Injury

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Effect of Treadmill Training on Gait and Functional Independence in Patients with Incomplete Spinal Cord Injury: A Case Series

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2012.1409 ◽

2012 ◽

Author(s):

Shahnawaz Anwer ◽

Ameed Equebal ◽

Ratnesh Kumar

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Walking Speed ◽

Case Series ◽

Gait Training ◽

Functional Independence ◽

Treadmill Training ◽

Incomplete Spinal Cord Injury ◽

Post Injury ◽

Cord Injury

Background and purpose: Many individuals with an incomplete spinal cord injury (SCI) have the potential to walk. The effectiveness of using a treadmill for gait training for these patients has been substantiated in the literature. This case series describes the effectiveness of incorporating gait training on a treadmill for two individuals with an incomplete SCI. Case Description: The treatments of two males each with an incomplete paraplegia were described. Subject 1 was 40 years old and was 14 months post injury at the time of the study. He had a T6 incomplete spinal cord injury classified as a D on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards. Subject 2 was 48 years old and was 10 months post injury. He had a T8 incomplete spinal cord injury classified as ASIA C. Intervention: Both subjects participated in gait training for a maximum of 10 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy programme.Results: An increase in step length, stride length, cadence, and comfortable walking speed were noted in both subjects. Both subjects improved their walking level as measured by the Walking Index for Spinal Cord Injury (WISCI II) and functional independence as measured by Spinal Cord Independent Measure (SCIM II). Conclusion: Gait training on a treadmill can improve gait parameters and functional independence in patients with incomplete paraplegia. Further research is needed to improve the generalizability of these findings and to identify which patients might benefit most from treadmill training.

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Gait Speed in Relation to Categories of Functional Ambulation After Spinal Cord Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308324224 ◽

2008 ◽

Vol 23 (4) ◽

pp. 343-350 ◽

Cited By ~ 64

Author(s):

Hubertus J. A. van Hedel

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sensitivity And Specificity ◽

Walking Speed ◽

High Sensitivity ◽

Walking Test ◽

Human Spinal Cord ◽

Receiver Operating Characteristic Curves ◽

Cord Injury ◽

European Multicenter Study

Objective. The aim of the present study was to assess gait speeds that distinguished between levels of functional ambulation in subjects with a spinal cord injury. Methods. The data of 886 spinal cord injury subjects were derived from the European Multicenter Study for Human Spinal Cord Injury and analyzed at 1, 3, 6, and 12 months after injury. The indoor and outdoor mobility items from the Spinal Cord Independence Measure were combined into 5 clinically relevant categories: (1) wheelchair-dependent, (2) supervised walker with outdoor wheelchair dependency, (3) indoor walker with outdoor wheelchair dependency, (4) walker with aid, and (5) walker without aid. The preferred walking speed that distinguished between ambulation categories was derived from the 10-meter walking test and determined using receiver operating characteristic curves. Results. The walking speed correlated well (>0.84) with the ambulation categories. The average walking speed for each category was (1) 0.01 m/s, (2) 0.34 m/s, (3) 0.57 m/s, (4) 0.88 m/s, and (5) 1.46 m/s. The average (± SD) speed that distinguished between the categories was 0.09 ± 0.01 m/s (1 vs 2), 0.15 ± 0.08 m/s (2 vs 3), 0.44 ± 0.14 m/s (3 vs 4), and 0.70 ± 0.13 m/s (4 vs 5). The averaged sensitivity and specificity were above 0.98 and 0.94, respectively. Conclusion. In subjects with spinal cord injury, the preferred walking speed as assessed in the clinic can be used to estimate functional ambulation during daily life. The walking speed can distinguish between ambulation categories with high sensitivity and specificity.

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