Review : Walking After Spinal Cord Injury: Control and Recovery

Barbeau, Hugues; Pépin, André; Norman, Kathleen E.; Ladouceur, Michel; Leroux, Alain

doi:10.1177/107385849800400109

Cited by 25 publications

(18 citation statements)

References 48 publications

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“…Spinal cord injury (SCI) leads to functional impairment, such as leg weakness and slow walking speed (1), and neurophysiologic impairment, such as a generalized upregulation of H-reflexes (2)(3)(4)(5). H-reflex testing is a reliable (6)(7)(8)(9)(10) technique that provides a window into the spinal cord to observe the neuromodulatory processes (11).…”

Section: Introductionmentioning

confidence: 99%

Soleus H-Reflex Modulation After Motor Incomplete Spinal Cord Injury: Effects of Body Position and Walking Speed

Phadke¹,

Thompson²,

Kukulka³

et al. 2010

The Journal of Spinal Cord Medicine

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Objective: To examine position-dependent (semireclined to standing) and walking speed-dependent soleus H-reflex modulation after motor incomplete spinal cord injury (SCI). Participants: Twenty-six patients with motor incomplete SCI (mean: 45 ± 15 years) and 16 noninjured people (mean: 38 ± 14 years). Methods: Soleus H-reflexes were evoked by tibial nerve stimulation. Patients were tested in semireclined and standing positions (experiment 1) and in midstance and midswing positions (experiment 2).Results: H-reflexes were significantly greater after SCI in all positions compared with noninjured people (P , 0.05). Position-dependent modulation from semireclined to standing (normally observed in noninjured people) was absent after SCI. In SCI patients, H-reflex modulation was not significantly different at 1.2 m/s compared with 0.6 m/s treadmill walking speed; in noninjured people, H-reflex modulation was significantly greater at 1.2 m/s compared with 0.6 m/s treadmill walking speed. There was a significant positive correlation between modified Ashworth scores, a clinical measure of spasticity and soleus H-reflex amplitudes tested in all positions. A significant negative correlation was also found between H-reflexes in standing and midstance positions and the amount of assistance patients required to walk. Conclusions: An improvement in position-dependent and walking speed-dependent reflex modulation after SCI may indicate functional recovery. Future studies will use H-reflex testing to track changes as a result of therapeutic interventions.

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Section: Introductionmentioning

confidence: 99%

Soleus H-Reflex Modulation After Motor Incomplete Spinal Cord Injury: Effects of Body Position and Walking Speed

Phadke¹,

Thompson²,

Kukulka³

et al. 2010

The Journal of Spinal Cord Medicine

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“…7 The walking ability of SCI subjects can be greatly improved quantitatively and qualitatively with appropriate interventions. [8][9][10] However, it is not known if this is also reflected in the capacity to adapt to changes in the mechanical demand of the task, as often observed in a changing environment. Thus, an important question remains: can SCI subjects adapt their walking pattern over a wide range of speeds?…”

Section: Introductionmentioning

confidence: 99%

Treadmill walking in incomplete spinal-cord-injured subjects: 1. Adaptation to changes in speed

2003

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Walking in spinal-cord-injured (SCI) subjects is usually achieved at a lower speed than in normal subjects. Study design/methods: Time and distance parameters, angular displacements of lower limbs and electromyographic (EMG) activity were measured for seven normal and seven SCI subjects at several walking speeds. Analyses of variance were used for comparing groups and speeds. Objectives: First, to measure the adaptability of SCI subjects' walking pattern to different speeds (0.1-1.0 m/s), and to compare it to that of normal subjects. Second, to characterize SCI subjects' walking pattern as compared to that of normal subjects at a matched treadmill speed (0.3 m/s). Setting: University-Based Human Gait Laboratory, Montreal, Canada. Results: SCI subjects' pattern adapted to a limited range of speeds. Longer cycle duration, flexed knee at foot contact, increased hip joint flexion at foot contact and during swing, and altered coordination of hip and knee joints were found for the SCI group. At all speeds, duration of muscle activity was longer in the SCI group and the increase in amplitude of soleus EMG activity at higher speeds was not specific to push-off. The importance of matching the walking speed of SCI and normal subjects in order to differentiate the features that are a consequence of SCI subjects' reduced walking speed rather than a direct consequence of the injury is demonstrated. Conclusions: All SCI subjects could adapt to a narrow range of speeds and only three could reach the maximal tested speed. This limited maximal speed seems to be a consequence of SCI subjects having reached their limit in increasing stride length and not being able to increase stride frequency further. This limitation in increasing stride frequency is likely because of the altered neural drive. Sponsorship: Neuroscience Network of the Canadian Centre of Excellence.

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“…Signi®cant achievements have been made in the enhancement of ambulation in persons with incomplete SCI using various orthoses and assistive devices, 4 medication, locomotor training with weight support and functional electrical stimulation. 5,6 According to Tang et al 4 approximately one-third of all SCI patients become functional ambulators with 1 year after the incident. However, the quality and method of mobility adopted vary from one patient to another.…”

Section: Introductionmentioning

confidence: 99%

Functional community ambulation requirements in incomplete spinal cord injured subjects

et al. 2001

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Study design: A group of people with incomplete spinal cord injuries (SCI) were evaluated and compared with able-bodied individuals during several walking conditions. Objectives: To evaluate the functional community ambulation and estimated energy expenditure in persons with incomplete SCI and able-bodied individuals. Methods: A list of criteria was used to evaluate functional community ambulation among participants. Physiological variables, such as the heart rate, oxygen uptake and the lactate concentration, were also measured. Results: Three of nine incomplete SCI subjects and all able-bodied subjects were able to meet all the criteria measured. The required velocity to safely cross an intersection was the criterion that the incomplete SCI group had the most di culty reaching. The able-bodied subjects had a comfortable walking velocity twice that of the incomplete SCI subjects' preferred velocity. When walking at the same velocity (incomplete SCI subjects' preferred velocity), the incomplete SCI subjects had a rate of oxygen uptake 26% greater than the healthy subjects and were 200% less e cient. The lactate concentration also proved to be a useful tool when evaluating the incomplete SCI subjects' walking e ciency. The incomplete SCI subjects lactate concentration increased after walking at their preferred velocity, meaning that the anaerobic pathways were used to meet energy demands. Conclusion: Rehabilitation centers should adapt their evaluation forms and increase their criteria requirements to more suitable criteria that are found in the SCI patient's community. The physiological cost should also be taken into consideration when evaluating the SCI patient's functional ambulation.

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Review : Walking After Spinal Cord Injury: Control and Recovery

Cited by 25 publications

References 48 publications

Soleus H-Reflex Modulation After Motor Incomplete Spinal Cord Injury: Effects of Body Position and Walking Speed

Soleus H-Reflex Modulation After Motor Incomplete Spinal Cord Injury: Effects of Body Position and Walking Speed

Treadmill walking in incomplete spinal-cord-injured subjects: 1. Adaptation to changes in speed

Functional community ambulation requirements in incomplete spinal cord injured subjects

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