Background Spinal cord injury affects walking balance control, which necessitates methods to quantify balance ability. The purposes of this study were to 1) examine walking balance through foot placement variability post-injury; 2) assess the relationship between measures of variability and clinical balance assessments; and 3) determine if spatial parameter variability might be used as a clinical correlate for more complex balance measurements. Methods Ten persons with spinal cord injury walked without devices on a split-belt treadmill at self-selected speeds. Ten healthy controls walked at 0.3 and 0.6 m/s for comparison. Variability of step width and length, anteroposterior and mediolateral foot placements relative to center-of-mass, and margin-of-stability were calculated. Clinical assessments included Berg Balance Scale and Dynamic Gait Index. Findings Participants with spinal cord injury demonstrated significantly different variability in all biomechanical measures compared to controls (P≤0.007). Berg Balance Scale scores were significantly inversely associated with step length as well as anteroposterior and mediolateral foot placement variability (P≤0.05). Dynamic Gait Index scores were significantly inversely associated with mediolateral foot placement variability (P≤0.05). Participants with spinal cord injury showed significant correlations between spatial parameter variability and all other measures (P≤0.005), except between step length and margin-of-stability (P=0.068); controls revealed fewer correlations. Interpretation Persons post-spinal cord injury exhibit an abnormal amount of stepping variability when challenged to walk without devices, yet preserve the ability to avoid falling. When complex laboratory measures of variability are unavailable clinically, spatial parameter variability or standardized balance assessments may be plausible indicators of walking balance control.
Objectives Determine the presence of walking-related arm swing following spinal cord injury (SCI), associated factors, and whether arm swing may change following locomotor training (LT). Design Observational, cross-sectional study from a convenience sample with pre-test/post-test from a sample subset. Setting Malcom Randall VAMC and University of Florida, Gainesville, FL. Methods Arm movement was assessed during treadmill stepping, pre-LT, in 30 individuals with motor incomplete SCI (iSCI, American Spinal Injury Association Impairment Scale grade C/D, as defined by the International Standards for Neurological Classifications of SCI, with neurological level of impairment at or below C4). Partial body weight support and manual-trainer assistance was provided, as needed, to achieve stepping and allow arm swing. Arm swing presence was compared based on cervical versus thoracic neurological levels of impairment and device type. Leg and arm strength and walking independence were compared between individuals with and without arm swing. Arm swing was re-evaluated post-LT in the 21/30 individuals that underwent LT. Results Of 30 individuals with iSCI, 12 demonstrated arm swing during treadmill stepping, pre-LT. Arm movement was associated with device type, lower extremity motor scores, and walking independence. Among the 21 individuals that received LT, only 5 demonstrated arm swing pre-LT. Of the 16 individuals lacking arm swing pre-LT, 8 integrated arm swing post-LT. Conclusion Devices routinely used for walking post-iSCI appeared associated with arm swing. Post-LT, arm swing presence increased. Therefore, arm swing may be experience-dependent. Daily neuromuscular experiences provided to the arms may produce training effects, thereby altering arm swing expression.
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