Abstract
Background: Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy.Methods: Individuals with chronic iSCI had to complete 6 days (1 day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task.Results: Four of five study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93 ± 1.54 to 2.18 ± 1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40 ± 1.18 to 2.20 ± 0.90). Direct influences of FB ranged from 60 to 15% of reduction in mean ND compared to initial gait analysis and from 20 to 1% compared to no-FB sessions.Conclusions: Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living.
Highlights
A spinal cord injury (SCI) leads to persistent sensorimotor impairments in the lower and upper extremities (McDonald and Sadowsky, 2002) resulting in limitations of mobility and participation in society
The aim of this study was to test if individuals with incomplete SCI (iSCI) can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy
Direct influences of FB ranged from 60 to 15% of reduction in mean norm distance (ND) compared to initial gait analysis and from 20 to 1% compared to no-FB sessions
Summary
A spinal cord injury (SCI) leads to persistent sensorimotor impairments in the lower (paraplegia) and upper (tetraplegia) extremities (McDonald and Sadowsky, 2002) resulting in limitations of mobility and participation in society. Individuals with initially preserved motor functions below the level of lesion have a good prognosis to become ambulatory after 3–6 month (Katoh and el Masry, 1995; Burns et al, 1997). Even in those subjects who reach a sufficient level of ambulation, sensory and in particular proprioceptive impairments or spasticity may be present and limiting walking function. Adaptation of the walking pattern to changing environments is mainly controlled by cerebellar and cerebral motor areas (Morton and Bastian, 2006). Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy
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