Abstract
BackgroundMany people with incomplete spinal cord injury (iSCI) have the ability to maneuver while walking. However, neuromuscular impairments create challenges to maintain stability. How people with iSCI maintain stability during walking maneuvers is poorly understood. Thus, this study compares maneuver performance in varying external conditions between persons with and without iSCI to better understand maneuver stabilization strategies in people with iSCI.MethodsParticipants with and without iSCI walked on a wide treadmill and were prompted to perform lateral maneuvers between bouts of straight walking. Lateral force fields applied to the participants’ center of mass amplified or attenuated the participants’ movements, thereby increasing the capability of the study to capture behavior at varied levels of challenge to stability.ResultsBy examining metrics of stability, step width, and center of mass dynamics, distinct strategies emerged following iSCI. The minimum margin of stability (MOSmin) on each step during maneuvers indicated persons with iSCI generally adapted to amplified and attenuated force fields with increased stability compared to persons without iSCI, particularly using increased step width and reduced center of mass excursion on maneuver initiation. In the amplified field, however, persons with iSCI had a reduced MOSmin when terminating a maneuver, likely due to the challenge of the force field opposing the necessary lateral braking. Persons without iSCI were more likely to rely on or oppose the force field when appropriate for movement execution. Compared to persons with iSCI, they reduced their MOSmin to initiate maneuvers in the attenuated and amplified fields and increased their MOSmin to arrest maneuvers in the amplified field.ConclusionsThe different force fields were successful in identifying relatively subtle strategy differences between persons with and without iSCI. Specifically, persons with iSCI adopted increased step width and reduction in center of mass excursion to increase maneuver stability in the amplified field. The amplified field may provoke practice of stable and efficient initiation and arrest of walking maneuvers. Overall, this work allows better framing of the stability mechanisms used following iSCI to perform walking maneuvers.
Highlights
Many people with incomplete spinal cord injury have the ability to maneuver while walking
A few maneuvers within both groups, in the Attenuated field, had one (17.9%) or at most two (1.2%) intermediate steps on the foot contralateral to the maneuver direction before the Center of mass (COM) was in the target lane
While it may be expected for individuals with incomplete spinal cord injury (iSCI) to increase cautiousness and Minimum margin of stability (MOSmin) in the Amplified field, the larger M OSmin could be surprising in the Attenuated field, as a previous study of straight walking [6] showed adaptation to a Initiation step Based on previous work on maneuvers without force fields, we expected individuals to have a smaller margins of stability (MOS) on the initiation step compared to the execution and termination steps, which may allow for a faster maneuver but introduces stability vulnerability [4, 8]
Summary
Many people with incomplete spinal cord injury (iSCI) have the ability to maneuver while walking. How people with iSCI maintain stability during walking maneuvers is poorly understood. This study compares maneuver performance in varying external conditions between persons with and without iSCI to better understand maneuver stabilization strategies in people with iSCI. It is difficult to resolve the strategies people use to skillfully stabilize their bodies during walking maneuvers. Our understanding of how people adapt stepping strategies to manage stability during maneuvers is poor. The need to understand these stabilizing strategies among people who have sustained a motor-incomplete spinal cord injury (iSCI) is pressing. A greater understanding of how people manage stability during walking maneuvers could provide valuable insight for designing more effective interventions to enhance the ability to maneuver after iSCI
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