Study of muscle activation during in-water gait of SCI patients using surface EMG

Abstract

We compared muscle activation during in- and out-of-water gait of SCI patients to understand the influence of the aquatic ambient on rehabilitation programme. Twenty healthy subjects and 20 SCI patients were enrolled. All patients had retained walking ability (AIS C and D, lesion level C4-L2, age 18–70 years) and could ambulate indipendently for a minimum of 5 m with or without walking aids. We analyzed, with an surface 8 channel wireless EMG, the following muscles of the right leg: rectus femoris, vastus medialis, vastus lateralis, gluteus maximus, gluteus medius, biceps femoris, tibialis anterior, gastrocnemius medialis. In both healthy and affected subjects in water the walking speed decreases whereas the duration of gait cycle increases. Furthermore in SCI patients we found out an increase of the swing phase. Comparing in- and out-of-water results for SCI subjects the maximum muscle activation peak in water occurred before than on dry land; at the opposite in healthy subjects we registered that the maximum muscle activation peak occurred earlier out of the pool. The in-water gait cycle is much more similar between SCI and healthy subjects than the out-of-water one. These results suggest that aquatic ambient could positively influence muscle recruitment in SCI patient. Moreover these data give us the opportunity to design water-based exercises that can enrich the tailored rehabilitation programme for every patient.