Introduction to Gait Rehabilitation in Spinal Cord Injury
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Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson
Introduction[edit | edit source]
Plasticity-Based Approach[edit | edit source]
The plasticity-based approach in gait rehabilitation in spinal cord injury arises from the research on activity-dependent neural adaptation and training. The afferent input influences activity-dependent plasticity of the spinal cord which affect the neurobiological control of walking. [1] The examples can be found in the studies by Sherrington[2], Grillner and Rossignol [3] who looked at the input of hip position and the effect of load on retraining walking after SCI. As the result of these studies, the rehabilitation strategies to regain the ability to ambulate by the patient with a spinal cord injury focused on hip extension, load and other sensory elements to facilitate walking.
In plasticity-based approach a specific task, like locomotion undergoes intensive practice in a specific training environment, while an appropriate sensory input is provided. The training environment may include treadmill with body-weight support (BWS), lokomat, or Exoskeleton. The sensory input can be offered in a form of limb loading and unloading, trunk posture, hip extension, or limb kinematics.
intense practice of the specific task, locomotion; providing appropriate sensory input (loading and unloading, trunk posture, hip extension, limb kinematics) associated with the locomotor task to tap the intrinsic neural networks generating stepping activity; permissiveness of the training environment (treadmill speed, body-weight support [BWS]) to enhance practice of the locomotor task; integration of postural control as a corequisite for locomotion; and minimizing compensation (load bearing through the legs versus load bearing through the arms, hip hiking for swing)
Locomotor Training[edit | edit source]
Goal: to generate stepping in response to specific afferent input associated with the task of walking
General guidelines: to maximize loading of the lower limbs through body-weight support systems or overground walking with assistive devices
Compensatory-Based Approach[edit | edit source]
"compensation as a rehabilitation strategy for nonremediable deficits of strength (force-generating capacity), voluntary motor control, sensation, and balance".
patient learns to compensate, using other abilities to complete a task, or to modify the task or the environment to accomplish the goal
outcomes based on the degree of motor and sensory loss from total to partial
to support and compensate for paresis or paralysis using braces and assistive devices; to teach new movement strategies to accomplish activities of daily living, including dressing, transfers, and bed mobility; to teach new strategies for upright mobility that incorporate braces and assistive devices; and to teach wheelchair mobility skills.
Predictors for Functional Outcome of Walking[edit | edit source]
International Standards for Neurological Classification of Spinal Cord Injury[edit | edit source]
N3 motor score, meaning the myotome examination of the quadriceps. L5 motor score, which is the myotome score for the big toe extensors, and S1 sensory score, light touch score. the score greater than 33 likely to be able to regain walking one year after injury
injury severity[edit | edit source]
is classified as ASIA A, B, C, D, or E,
Assistive Devices[edit | edit source]
Orthosis[edit | edit source]
Ambulatory Devices[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Van de Crommert HW, Mulder T, Duysens J. Neural control of locomotion: sensory control of the central pattern generator and its relation to treadmill training. Gait Posture. 1998 May 1;7(3):251-263.
- ↑ Sherrington CS. Flexion-reflex of the limb, crossed extension-reflex, and reflex stepping and standing. J Physiol. 1910 Apr 26;40(1-2):28-121.
- ↑ Grillner S, Rossignol S. On the initiation of the swing phase of locomotion in chronic spinal cats. Brain Res. 1978 May 12;146(2):269-77.
