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.
Example: Locomotor training using a Lokomat.
- The goal is to generate stepping in response to specific afferent input associated with the task of walking
- The general guidelines focus on maximising loading of the lower limbs through body-weight support systems or overground walking with assistive devices
Compensatory-Based Approach[edit | edit source]
Compensation is "a rehabilitation strategy for non-remediable deficits of strength (force-generating capacity), voluntary motor control, sensation, and balance."[4]It is based on the principles that patients use their remaining abilities (compensate) to complete the task, or the task or environment are modified to achieve the established goal.[4]
In compensatory-based approach a task of walking is accomplished with the use of orthosis and assistive devices, and the outcome depends on the degree of motor and sensory loss.
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.
- ↑ 4.0 4.1 Behrman AL, Bowden MG, Nair PM. Neuroplasticity after spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery. Phys Ther. 2006 Oct;86(10):1406-25.
