Abstract
Individuals with chronic incomplete spinal cord injury (SCI) are at an increased risk for falls due to impaired neural pathways, thus leading to a decreased ability to initiate a protective stepping reaction to prevent falls. This case report demonstrated the use of an 8-week, task-specific, perturbation-based balance training (PBT) program and assessed the impact on functional outcome measures in a 58-year old male 18 months post incomplete SCI as a result of surgical tumor removal. Interventions within this program were designed to be salient and task-specific while providing optimal challenge in a safe and controlled environment. Therefore, activities in this program did not require the use of complex laboratory equipment and instead focused on intervention strategies and outcomes that could be utilized with any clinician in a variety of settings. Improvements in all outcome measures, decreased fall risk and number of falls, and improved ability to take a protective stepping reaction were noted after conclusion of the program. These results suggest that perturbation-based balance training within the framework of functional and salient interventions can lead to improved outcomes in those with chronic incomplete SCI. Future work should continue to investigate the effects of PBT with task-specific interventions within this population as well as its impact on standardized outcome measures.
Highlights
There are 282,000 people with a spinal cord injury (SCI) living in the United States and approximately 17,000 new cases occur each year.[1]
A protective stepping reaction is a necessary reactive balance response to prevent falls resulting from postural perturbations,[5,6,7,8,9] and people with an ineffective stepping reaction are likely at an increased risk for falls.[6]
Functional stability during gait improved from scores on the DGI of 15/24 to 17/24, but not enough to reach the minimal detectable change (MDC) for the stroke population as determined by Jonsdottir, et al.[24]
Summary
There are 282,000 people with a spinal cord injury (SCI) living in the United States and approximately 17,000 new cases occur each year.[1]. Falls are a significant problem among ambulatory patients with incomplete SCI, with approximately 75% suffering a fall within one year.[4] 45% of those with incomplete SCI reported that falls restricted their ability to engage in the community and participate in productive activity.[4] While ankle and hip strategies have been found to be effective ways to maintain balance and prevent falls following perturbations, a stepping strategy, or reaction, has been found to be successful and even the preferred strategy.[5] Horak, et al[5] defined a stepping reaction as an “asymmetrical loading and unloading of the legs to move the base of support under the falling center of mass” and Mansfield, et al[6] further stated that in order to prevent falls, this motion must occur quicker than a typical voluntary movement. A protective stepping reaction is a necessary reactive balance response to prevent falls resulting from postural perturbations,[5,6,7,8,9] and people with an ineffective stepping reaction are likely at an increased risk for falls.[6]
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