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

Abstract

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.

Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life

“…9 Up to now, the effectiveness of TT combined with BWS in patients with an ISCI has been almost exclusively evaluated at the level of body functions, 10 mostly by electromyography or measuring speed and BWS on the treadmill. [3][4][5][6][7][8]11,12 A couple of studies have also measured walking over ground, 3,4,7,13 but only a few have measured walking-related activities. 3,13 While results are generally positive, 3,4,7,13 little is known about the effect of TT on the functional health status (FHS) and quality of life (QoL) of patients with an ISCI, even though changes of FHS are considered an important aspect of rehabilitation.…”

Increases in Corticospinal Tract Function by Treadmill Training After Incomplete Spinal Cord Injury

“…However, training stroke patients at fast speeds of walking on the treadmill results in faster self-selected velocities of overground walking (Pohl et al 2002;Sullivan et al 2002). In addition, the more normal gait produced at higher velocities of walking may allow subjects to concentrate more on the overall gait pattern rather than on individual muscles (Pepin et al 2003). Thus further studies examining the effect of training speed on locomotor recovery in both acute and chronic injury are required.…”

Limits of locomotor ability in subjects with a spinal cord injury

“…16 Furthermore, they can adapt gait speed, but only within a limited range and are unable to increase stride frequency. 17 In addition, it is unknown whether SCI subjects experience differences in the acquisition of adaptive locomotor tasks during or after the rehabilitation program. Since improvement in motor performance strongly depends on feedback mechanisms, it could be expected that locomotor learning might be affected in SCI patients, since tactile and proprioceptive inputs are often impaired in SCI, as well as motor function.…”