Abstract
Background: Recovery of walking function after neurotrauma, e.g., after spinal cord injury, is routinely captured using standardized walking outcome measures of time and distance. However, these measures do not provide information on possible underlying mechanisms of recovery, nor do they tell anything about the quality of gait. Subjects with an incomplete spinal cord injury are a very heterogeneous group of people with a wide range of functional impairments. A stratification of these subjects would allow increasing sensitivity for hypothesis testing and a more targeted treatment strategy.Methods: The gait of incomplete spinal cord injured subjects was compared to healthy control subjects by analyzing kinematic data obtained by a 3-D motion capture system. Hip–knee angle-angle plots (cyclograms) informed on the qualitative aspect of gait and the intralimb coordination. Features of the cyclogram, e.g., shape of the cyclogram, cycle-to-cycle consistency and its modulation due to changes in walking speed were discerned and used to stratify spinal cord injured subjects.Results: Spinal cord injured subjects were unable to modulate their cyclogram configuration when increasing speed from slow to preferred. Their gait quality remained clearly aberrant and showed even higher deviations from normal when walking at preferred speed. Qualitative categorization of spinal cord injured subjects based on their intralimb coordination was complemented by quantitative measures of cyclogram shape comparison.Discussion: Spinal cord injured subjects showed distinct distortions of intralimb coordination as well as limited modulation to changes in walking speed. The specific changes of the cyclograms revealed complementary insight in the disturbance of lower-limb control in addition to measures of time and distance and may be a useful tool for patient categorization and stratification prior to clinical trial inclusion.
Highlights
The most obvious impairment after spinal cord injury (SCI) is the complete or partial loss of lower-limb motor function, clinically assessed as decreased walking speed and alterations in time– distance measures
Qualitative categorization of spinal cord injured subjects based on their intralimb coordination was complemented by quantitative measures of cyclogram shape comparison
These features are listed in the box on the left of Figure 1A. incomplete SCI (iSCI) subjects showed one or more alterations of certain properties of the cyclogram and depending on the degree of deviation were classified into four groups of impairment (Figure 1B)
Summary
The most obvious impairment after spinal cord injury (SCI) is the complete or partial loss of lower-limb motor function, clinically assessed as decreased walking speed and alterations in time– distance measures (e.g., step length, step frequency, double-, and single-limb support phase; Krawetz and Nance, 1996; Pepin et al, 2003). These parameters are often used to monitor recovery and to capture locomotor capacity, but they lack the ability to unveil underlying neurological mechanisms (Dobkin et al, 2006; Tamburella et al, 2013). A stratification of these subjects would allow increasing sensitivity for hypothesis testing and a more targeted treatment strategy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
