Evidence-based therapy for recovery of function after spinal cord injury.

Physical rehabilitation for individuals coping with neurological deficits is evolving in response to a paradigm shift in thinking about the injured nervous system and using evidence as a basis for clinical decisions. Functional recovery from paralysis was generally believed to be nearly impossible, based on traditional expert opinion, and the priority was to develop compensation strategies to achieve functional goals in the home and community. Research, which began in animal models of neurological insult and is currently being translated to the clinic, has challenged these assumptions.

Arm and leg coordination during treadmill walking in individuals with motor incomplete spinal cord injury: a preliminary study.

Arm and leg coordination naturally emerges during walking, but can be affected by stroke or Parkinson's disease. The purpose of this preliminary study was to characterize arm and leg coordination during treadmill walking at self-selected comfortable walking speeds (CWSs) in individuals using arm swing with motor incomplete spinal cord injury (iSCI). Hip and shoulder angle cycle durations and amplitudes, strength of peak correlations between contralateral hip and shoulder joint angle time series, the time shifts at which these peak correlations occur, and associated variability were quantified.

Chapter 16--spinal plasticity in the recovery of locomotion.

Locomotion is a very robust motor pattern which can be optimized after different types of lesions to the central and/or peripheral nervous system. This implies that several plastic mechanisms are at play to re-express locomotion after such lesions. Here, we review some of the key observations that helped identify some of these plastic mechanisms.

Neuromotor and musculoskeletal responses to locomotor training for an individual with chronic motor complete AIS-B spinal cord injury.

Background/objective: To determine the effects of locomotor training (LT) using body weight support (BWS), treadmill, and manual assistance on muscle activation, bone mineral density (BMD), and body composition changes for an individual with motor complete spinal cord injury (AIS B), 1 year after injury.

Methods: A man with chronic C6 AIS B (motor complete and sensory incomplete) spinal cord injury (SCI), 1 year after injury, completed 2 blocks of LT over a 9-month training period (35-session block followed by 8.6 weeks of no training and then a 62-session block).

Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.

Objective: To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT).

Design: Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). PARTICIPANTS/ METHODS: Body weight-supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks.

Postural adaptation to walking on inclined surfaces: II. Strategies following spinal cord injury.

Objective: To investigate the postural adaptations to inclined walking in spinal cord injured (SCI) subjects.

Methods: Eight subjects with an incomplete spinal cord injury and eight age- and sex-matched healthy control subjects walked on a treadmill at five different grades (from -10 to 10%) without any assistance. The movements of the trunk and pelvis were recorded with four high-resolution cameras.

Physical determinants, emerging concepts, and training approaches in gait of individuals with spinal cord injury.

The aim of this review is to examine the physical determinants for functional walking as well as the efficacy of gait rehabilitation after spinal cord injury (SCI) in humans. The results indicate several important physical determinants in gait. Examples are provided of different interventions that produce beneficial effects on outcome measures of gait such as gait speed, stride length, walking endurance, motor recovery, and gait quality.

Speed and temporal-distance adaptations during treadmill and overground walking following stroke.

Objective: To compare the maximum gait speed of stroke subjects attained during treadmill and overground in stroke subjects and to identify the temporal-distance determinants of the maximal gait speed.

Methods: Ten individuals with hemiparetic gait deficits and whose walking speeds ranged between 0.24 m/s and 0.

Timing of cortical excitability changes during the reaction time of movements superimposed on tonic motor activity.

Seated subjects were instructed to react to an auditory cue by simultaneously contracting the tibialis anterior (TA) muscle of each ankle isometrically. Focal transcranial magnetic stimulation of the leg area of the motor cortex (MCx) was used to determine the time course of changes in motor-evoked potential amplitude (MEP) during the reaction time (RT). In one condition the voluntary contraction was superimposed on tonic EMG activity maintained at 10% of maximal voluntary contraction.

Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects.

Objectives: To identify stroke patients who are most likely to benefit from locomotor training with body-weight support (BWS), to determine the extent of carryover from treadmill training to overground locomotion, and to determine the variables that are most likely to influence the recovery of locomotion.

Design: A randomized clinical trial.

Setting: Inpatient rehabilitation hospital.

Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injury.

The authors describe the rationale and methodology for the first prospective, multicenter, randomized clinical trial (RCT) of a task-oriented walking intervention for subjects during early rehabilitation for an acute traumatic spinal cord injury (SCI). The experimental strategy, body weight-supported treadmill training (BWSTT), allows physical therapists to systematically train patients to walk on a treadmill at increasing speeds typical of community ambulation with increasing weight hearing. The therapists provide verbal and tactile cues to facilitate the kinematic, kinetic, and temporal features of walking.

Effects of intrathecal glutamatergic drugs on locomotion. II. NMDA and AP-5 in intact and late spinal cats.

In a previous article, we have shown that, in cats, intrathecal injections of N-methyl-D-aspartate (NMDA) in the first few days after spinalization at T13 do not induce locomotion as in many other spinal preparations. This is in contrast to alpha-2 noradrenergic receptor stimulation, which can trigger locomotion at this early stage. However, it is known that spinal cats do recover spontaneous locomotion in the absence of descending noradrenergic pathways and that the spinal pattern generator must then depend on other neurotransmitters still present in the cord such as excitatory amino acids.

Kinematic adaptations of spinal cord-injured subjects during obstructed walking.

Study Design: A case-control study of walking over obstacles.

Objective: To characterize and compare the kinematic, anticipatory locomotor adjustments used by people with incomplete spinal cord injuries (SCIs).

Methods: The angular and linear kinematics of the lower limb when going over obstacles of low height (0.

The effects of long-term FES-assisted walking on intrinsic and reflex dynamic stiffness in spastic spinal-cord-injured subjects.

The effects of long-term functional electrical stimulation (FES)-assisted walking on ankle dynamic stiffness were examined in spinal cord-injured (SCI) subjects with incomplete motor function loss. A parallel-cascade system identification method was used to identify intrinsic and reflex contributions to dynamic ankle stiffness at different ankle positions while subjects remained relaxed. Intrinsic stiffness dynamics were well modeled by a linear second-order model relating intrinsic torque to joint position.

The effect of locomotor training combined with functional electrical stimulation in chronic spinal cord injured subjects: walking and reflex studies.

With the new developments in traumatology medicine, the majority of spinal cord injuries sustained are clinically incomplete and the proportion is likely to continue to rise. Thus, it is necessary to continue to develop new treatment and rehabilitation strategies and understand the factors that can enhance recovery of walking following spinal cord injury (SCI). One new development is the use of functional electrical stimulation (FES) device to assist locomotion.

Effects of intrathecal glutamatergic drugs on locomotion I. NMDA in short-term spinal cats.

Excitatory amino acids (EAA) have been reported to induce fictive locomotion in different in vitro and in vivo preparations in a variety of species through their actions on both N-methyl-D-aspartate (NMDA), and non-NMDA receptors. NMDA-induced intrinsic membrane properties such as intrinsic motoneuronal membrane oscillations and plateau potentials have been suggested to play a role in the generation of locomotion. There is, however, no information on the ability of NMDA in triggering spinal locomotion in awake behaving animals.

Postural adaptation to walking on inclined surfaces: I. Normal strategies.

This study investigated the postural strategies to adapt to uphill and downhill treadmill inclination (0, 5 and 10%) during walking and standing in eight healthy subjects. Increasing the treadmill grade from 0 to 10% induced an increasingly flexed posture of the hip, knee and ankle at initial foot contact as well as a progressive forward tilt of pelvis and trunk. These postural changes were accompanied by a progressive decrease in pelvic lateral drop toward the swinging limb and a gradual increase in stride length as the uphill slope became steeper.