Fig 2 - uploaded by Paula L Chapman
Content may be subject to copyright.
Treadmill and Overground Adapt-locomotor training. a Participant SCI01 performing obstacle negotiation on treadmill. b Participant SCI02 performing backward walking on treadmill. c Participant SCI03 performing obstacle negotiation overground. d Participant SCI02 performing backward walking overground. TM treadmill, OG overground
Source publication
Introduction
Functional walking requires the ability to modify one’s gait pattern to environmental demands and task goals—gait adaptability. Following incomplete spinal cord injury (ISCI), gait rehabilitation such as locomotor training (Basic-LT) emphasizes intense, repetitive stepping practice. Rehabilitation approaches focusing on practice of gai...
Context in source publication
Context 1
... walking) [16][17][18]. Thus, based on these factors, Adapt-LT emphasized the same general principles as Basic-LT and also included practice of adaptability tasks (obstacle negotiation, back- ward walking, and speed changes) (Figs. 1b and 2a-d). During training on the treadmill the goal was to spend a minimum of 5 min on each adaptability task (Fig. 2): 1. Obstacle negotiation -Obstacles were delivered bilat- erally and included foam blocks and boxes of variable sizes (height range: 5-14 cm; width range: 20-39 cm; depth range: 5-24 cm). Progression of the task included increas- ing obstacle frequency, varying rates of obstacle delivery, and increasing obstacle size. 2. Speed ...
Similar publications
Background:
Body weight support (BWS) is often provided to incomplete spinal cord injury (iSCI) patients during rehabilitation to enable gait training before full weight-bearing is recovered. Emerging robotic devices enable BWS during overground walking, increasing task-specificity of the locomotor training. However, in contrast to a treadmill set...
Traumatic spinal cord injury (SCI) results in some serious neurophysiological consequences that alter healthy body functions and devastate the quality of living of individuals. To find a cure for SCI, researchers around the world are working on different neurorepair and neurorehabilitation modalities. To test a new treatment for SCI as well as to u...
Citations
... In mammalian (e.g., human) spinal cord injury, substantial recovery of locomotory function can be observed depending on the level of injury and age of the subject (Tillakaratne et al., 2010;Rossignol and Frigon, 2011;Pizzolato et al., 2021). However, it is not known whether the robustness, an ability to withstand external perturbations, is also restored along with recovery of the locomotion, e. g., obstacles (van Hedel et al., 2005;Fox et al., 2017). In the present study, we assessed the ability of a well-known rhythm-generating network, the Cancer borealis pyloric network, to homeostatically recover the robustness of its neural activity to external perturbations after the activity has been severely disrupted. ...
Robustness of neuronal activity is a property necessary for a neuronal network to withstand perturbations, which may otherwise disrupt or destroy the system. The robustness of complex systems has been shown to depend on a number of features of the system, including morphology and heterogeneity of the activity of the component neurons, size of the networks, synaptic connectivity, and neuromodulation. The activity of small networks, such as the pyloric network of the crustacean stomatogastric nervous system, appears to be robust despite some of the factors not being consistent with the expected properties of complex systems, e.g., small size and homogeneity of the synaptic connections. The activity of the pyloric network has been shown to be stable and robust in a neuromodulatory state-dependent manner. When neuromodulatory inputs are severed, activity is initially disrupted, losing both stability and robustness. Over the long term, however, stable activity homeostatically recovers without the restoration of neuromodulatory input. The question we address in this study is whether robustness can also be restored as the network reorganizes itself to compensate for the loss of neuromodulatory input and recovers the lost activity. Here, we use temperature changes as a perturbation to probe the robustness of the network’s activity. We develop a simple metric of robustness, i.e., the variances of the network phase relationships, and show that robustness is indeed restored simultaneously along with its stable network activity, indicating that, whatever the reorganization of the network entails, it is deep enough also to restore this important property.
... The SCI-FAP is a valid, reliable, and responsive measure of walking skills for adults with SCI [13,14]. It has been used in research to validate multiple assessment tools [15,16] and to measure walking capacity during or after interventions [17][18][19][20][21]. The original SCI-FAP consists of seven tasks and it has been reduced to four tasks in the Modified SCI-FAP [13,14]. ...
The Obstacles Test and Curb Test have been used to measure gait speed and functional balance in adults. Recently, they have been modified for use in children but the normative values have not been established. This requires correlating the sex, age, height, weight, and BMI% of children with the test results and developing prediction equations. In this cross-sectional study, the Obstacles Test and Curb Test were administered to a convenience sample of 240 typically developing children aged 6-11 years. The factors associated with the time to complete each test were studied and prediction equations were established. The completion times were 5.27 ± 0.81 s for the Obstacles Test and 2.82 ± 0.45 s for the Curb Test. The Obstacles Test showed a fair negative relationship with height (Pearson's r = -0.41, P < 0.001), age (r = -0.35, P < 0.001), and weight (r = -0.32, P < 0.05). The Curb Test also had fair negative correlations with height (r = -0.42, P < 0.001), age (r = -0.39, P < 0.001), and weight (r = -0.31, P < 0.001). Both tests showed poor correlations with the sex [eta (η) = 0.15 and 0.12, respectively]. Nonetheless, age and sex emerged as the main predictors of both test scores, accounting for 14% and 17% of the total variance in the Obstacles Test and Curb Test times, respectively. Normative values and prediction equations for both tests in typically developing children may be used for individual comparisons and in clinical research for the evaluation of interventions targeting disabled children.
... Millions of people suffer from walking disorders caused by brain injury [72]. The recovery of the walking function is the most important goal of rehabilitation for subjects with the spinal cord injury [73]. Apparently, effective rehabilitation of locomotor functions requires understanding the mechanisms of functioning of supraspinal locomotor centers in humans. ...
It is believed that real movements and those performed mentally (imaginary movements) are functionally similar. This hypothesis is based on the use of the imaginary movement approach for the investigation of the neurophysiological mechanisms of real movements of a person, as well as for rehabilitation and optimization of motor functions. A large body of evidence in favor of this hypothesis has been obtained for upper limb movements, whereas data on lower limb movements are quite scarce. The aim of this review is to generalize the published data that demonstrate the similarity of the mechanisms and brain structures involved in the organization of imaginary and real locomotion.
... In iSCI patients training precision stepping has been shown to improve walking capacity measured with the SCI functional ambulation profile [SCI-FAP, (24)]. More recently, however, Fox and colleagues concluded that the efficacy of gait adaptability training on walking and balance function should be further investigated (25). ...
Many patients with incomplete spinal cord injury (iSCI) have impaired gait and balance capacity, which may impact daily functioning. Reduced walking speed and impaired gait stability are considered important underlying factors for reduced daily functioning. With conventional therapy, patients are limited in training gait stability, but this can be trained on a treadmill in a virtual environment, such as with the Gait Real-time Analysis Interactive Lab (GRAIL). Our objective was to evaluate the effect of 6-weeks GRAIL-training on gait and dynamic balance in ambulatory iSCI patients. In addition, the long-term effect was assessed. Fifteen patients with chronic iSCI participated. The GRAIL training consisted of 12 one-hour training sessions during a 6-week period. Patients performed 2 minute walking tests on the GRAIL in a self-paced mode at the 2nd, and 3rd (baseline measurements) and at the 12th training session. Ten patients performed an additional measurement after 6 months. The primary outcome was walking speed. Secondary outcomes were stride length, stride frequency, step width, and balance confidence. In addition, biomechanical gait stability measures based on the position of the center of mass (CoM) or the extrapolated center of mass (XCoM) relative to the center of pressure (CoP) or the base of support (BoS) were derived: dynamic stability margin (DSM), XCoM-CoP distance in anterior-posterior (AP) and medial-lateral (ML) directions, and CoM-CoP inclination angles in AP and ML directions. The effect of GRAIL-training was tested with a one-way repeated measures ANOVA (α = 0.05) and post-hoc paired samples t-tests (α = 0.017). Walking speed was higher after GRAIL training (1.04 m/s) compared to both baseline measurements (0.85 and 0.93 m/s) (p < 0.001). Significant improvements were also found for stride length (p < 0.001) and stability measures in AP direction (XCoM-CoPAP (p < 0.001) and CoM-CoPAP−angle (p < 0.001)). Stride frequency (p = 0.27), step width (p = 0.19), and stability measures DSM (p = 0.06), XCoM-CoPML (p = 0.97), and CoM-CoPML−angle (p = 0.69) did not improve. Balance confidence was increased after GRAIL training (p = 0.001). The effects were remained at 6 months. Increased walking speed, stride length, AP gait stability, and balance confidence suggest that GRAIL-training improves gait and dynamic balance in patients with chronic iSCI. In contrast, stability measures in ML direction did not respond to GRAIL-training.
Background: To study and find the efficacy of early functional mobility training on functional independence in incomplete paraplegic individuals.
Methods: Ethical clearance was taken from the Institutional Ethical Committee.This study was conducted in Krishna Hospital, Karad with a sample size of 40. Those who were willing to participate in the study were included in the study by using convinient sampling method for incomplete paraplegic subjects.Distal muscle strength was assessed by MMT and functional mobility was assessed by FIMS and SCIM before and after the study.Proximal muscle strengthening exercises were given that included exercises with assistance followed by active exercises and then with progressively with resistance. The intervention had been given for 12 weeks and treatment will be given 5 times a week.
Result: Manual muscle testing shows extremely significant improvement in lower limb muscle strength with p value of 0.0001. Pre interventional value of mean and standard deviation for hip flexors was (2.52±0.51)(right), (2.65±0.48)(left) and post interventional value of mean and standard deviation was (3.44±0.50)(right), (3.08±1.62)(left) and also shows extremely significant improvement in hip flexor strength that is p value of <0.0001. Pre interventional value of mean and standard deviation for knee extensors was (2.38±0.60)(right), (2.52±0.51)(left) and post interventional value of mean and standard deviation was(3.54±0.50)(right), (3.75±0.55)(left) and also shows extremely significant improvement in hip flexor strength that is p value of <0.0001. Pre interventional value of
mean and standard deviation for ankle dorsiflexor was (2.52±0.51)(right), (2.65±0.48)(left) and post interventional value of mean and standard deviation was(3.44±0.50)(right), (2.79±2.14)(left) and also shows extremely significant improvement in hip flexor strength that is p value of <0.0001. Pre interventional value of mean and standard deviation for long toe extensor was (2.40±0.59)(right), (2.65±0.48)(left)and post interventional value of mean and standard deviation was(3.44±0.50)(right), (3.08±1.62)(left) and also shows extremely significant improvement in hip flexor strength that is p value of <0.0001.
Functional independence measure scale shows extremely significant improvement with p value of 0.0001. Pre interventional value of mean and standard deviation was (74.26±8.05) and post interventional value of mean and standard deviation was (96.92±8.04). Spinal Cord Independence Measure scale shows extremely significant improvement with p value of 0.0001. Pre interventional value of mean and standard deviation was (37.34±5.08)and post interventional value of mean and standard deviation was (67.65±6.84).Conclusion: This study concludes that functional mobility exercise 5 times a week is beneficial to improve the functional independence in incomplete paraplegic individuals. It also prevents secondary complications in the rehabilitation period and helps improve the quality of life.
