Task-Specific Versus Impairment-Based Training on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study

Background. Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective. The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific versus impairment-based interventions on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI >1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 weeks, with interventions alternated after >4 weeks delay. Both strategies focused on achieving higher cardiovascular intensities, with training specificity manipulated by practicing only stepping practice in variable contexts or practicing tasks targeting impairments underlying locomotor dysfunction (strengthening, balance tasks, and recumbent stepping). Results. Significantly greater increases in fastest overground and treadmill walking speeds were observed following task-specific versus impairment-based training, with moderate associations between differences in amount of practice and outcomes. Gains in balance confidence were also observed following task-specific vs impairment-based training, although incidence of falls was also increased with the former protocol. Limited gains were observed with impairment-based training except for peak power during recumbent stepping tests. Conclusion. The present study reinforces work from other patient populations that the specificity of task practice is a critical determinant of locomotor outcomes and suggest impairment-based exercises may not translate to improvements in functional tasks. Clinical Trial Registration URL. https://clinicaltrials.gov/ ; Unique Identifier: NCT02115685.

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Improved Intralimb Coordination in People With Incomplete Spinal Cord Injury Following Training With Body Weight Support and Electrical Stimulation

Physical Therapy ◽

10.1093/ptj/82.7.707 ◽

2002 ◽

Vol 82 (7) ◽

pp. 707-715 ◽

Cited By ~ 113

Author(s):

Edelle Carmen Field-Fote ◽

Dejan Tepavac

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Body Weight ◽

Electrical Stimulation ◽

Body Weight Support ◽

Step Cycle ◽

Weight Support ◽

Cord Injury ◽

Intralimb Coordination ◽

Walking Speeds

Abstract Background and Purpose. Limb coordination is an element of motor control that is frequently disrupted following spinal cord injury (SCI). The authors assessed intralimb coordination in subjects with SCI following a 12-week program combining body weight support, electrical stimulation, and treadmill training. Subjects. Fourteen subjects with long-standing (mean time post-SCI=70 months, range=12–171 months), incomplete SCI participated. Three subjects without SCI provided data for comparison. Methods. A vector-based technique was used to assign values to the frame-by-frame changes in hip/knee angle, and vector analysis techniques were used to assess how closely the hip/knee angles of each step cycle resembled those of every other step cycle. Overground and treadmill walking speeds also were measured. Results. Following training, 9 of the 14 subjects with SCI demonstrated greater intercycle agreement. Mean overground and treadmill walking speeds improved (84% and 158%, respectively). Discussion and Conclusion. The intervention used in this study is based on our current understanding of the role of afferent input in the production of walking. Although the study sample was small and there was no control group, results suggest that training may improve intralimb coordination in people with SCI.

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Towards a Mobile Gait Analysis for Patients with a Spinal Cord Injury: A Robust Algorithm Validated for Slow Walking Speeds

Sensors ◽

10.3390/s21217381 ◽

2021 ◽

Vol 21 (21) ◽

pp. 7381

Author(s):

Charlotte Werner ◽

Chris Awai Awai Easthope ◽

Armin Curt ◽

László Demkó

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Gait Analysis ◽

Clinical Decision Making ◽

Inertial Sensors ◽

Clinical Decision ◽

Cord Injury ◽

Spatio Temporal ◽

The Individual ◽

Walking Speeds

Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.

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Task Practice with or without Cellular Transplantation Promotes Recovery of Reach-to Grasp Function after Cervical Spinal Cord Injury

International Journal of Physical Medicine & Rehabilitation ◽

10.4172/2329-9096.1000239 ◽

2014 ◽

Vol 02 (06) ◽

Author(s):

Scott K Stackhouse

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Reach To Grasp ◽

Cellular Transplantation ◽

Cord Injury ◽

Task Practice

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Cell Therapy Strategies in the Repair of Spinal Cord Injury: Pros and Cons

The Neuroscience Journal of Shefaye Khatam ◽

10.18869/acadpub.shefa.4.1.55 ◽

2016 ◽

Vol 4 (1) ◽

pp. 55-66

Author(s):

Sara Abdolahi ◽

Hadi Aligholi ◽

Sadegh Shirian ◽

◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cell Therapy ◽

Cord Injury ◽

Pros And Cons ◽

Therapy Strategies

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Prednisolone Pretreatment Enhances Intermittent Hypoxia-Induced Plasticity in Persons With Chronic Incomplete Spinal Cord Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319872992 ◽

2019 ◽

Vol 33 (11) ◽

pp. 911-921 ◽

Cited By ~ 6

Author(s):

Milap S. Sandhu ◽

Elizabeth Gray ◽

Masha Kocherginsky ◽

Arun Jayaraman ◽

Gordon S. Mitchell ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Intermittent Hypoxia ◽

Interleukin 10 ◽

Voluntary Contraction ◽

Controlled Study ◽

Incomplete Spinal Cord Injury ◽

Clinical Trial Registration ◽

Cord Injury ◽

Anti Inflammatory

Objective. To test the hypothesis that an anti-inflammatory corticosteroid drug enhances spinal motor plasticity induced by acute intermittent hypoxia (AIH) in persons with chronic incomplete spinal cord injury (iSCI). Methods. Fourteen subjects with incomplete spinal cord injury (ASIA level C or D; mean age = 46 years) participated in a randomized, double-blinded, crossover, and placebo-controlled study. Subjects received either 60 mg oral prednisolone or a matching placebo, 1 hour before administration of AIH (15, 60-second hypoxic exposures; fraction of inspired oxygen [FiO2] = 0.09). Changes in voluntary ankle strength, lower extremity electromyograms (EMG), and serum inflammatory biomarkers were quantified. Results. Maximal ankle plantarflexion torque was significantly higher following prednisolone + AIH versus placebo + AIH (mean difference [MD] 9, 11, and 7 newton meter [N∙m] at 30, 60, and 120 minutes post-AIH, respectively; all Ps <.02). Soleus surface EMG during maximal voluntary contraction was also significantly increased following prednisolone + AIH (MD 3.5, P = .02 vs placebo + AIH), while activity of other leg muscles remained unchanged. Individuals had significantly higher levels of the anti-inflammatory serum biomarker interleukin-10 after prednisolone versus placebo ( P = .004 vs placebo + AIH). Conclusions. Pretreatment with prednisolone increased the capacity for AIH-induced functional motor plasticity, suggesting that suppression of inflammation enhances the efficacy of AIH administration in individuals with spinal cord injury. Clinical trial registration number: NCT03752749.

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The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial

Frontiers in Neurology ◽

10.3389/fneur.2021.620367 ◽

2021 ◽

Vol 12 ◽

Author(s):

Janelle Unger ◽

Katherine Chan ◽

Jae W. Lee ◽

B. Catharine Craven ◽

Avril Mansfield ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Randomized Clinical Trial ◽

Balance Training ◽

Drop Out ◽

Incomplete Spinal Cord Injury ◽

Clinical Trial Registration ◽

Cord Injury ◽

Reactive Stepping

Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.Design: Randomized clinical trial.Setting: Tertiary SCI/D rehabilitation center.Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations.Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes.Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training.Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02960178.

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