Abstract
BackgroundIn the field of spinal cord injury (SCI) research there is an emphasis on the ability to ambulate.PurposeTo determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants.MethodsThis was a cross-sectional study. Participants were recruited from seven SCI rehabilitation units within the Johannesburg area. The following were used: demographic questionnaire to capture participants’ characteristics, modified Ashworth scale for spasticity; goniometer for range of movement (ROM); American Spinal Injury Association (ASIA) scale for patient classification; accelerometer for EE and the six-minute walk test (6MWT) for endurance. Characteristics of the study participants were summarised using descriptive statistics. Data were analysed as follows: two-sample t-test for comparison between the able-bodied and SCI sample and Pearson product moment correlations for relationship between identified factors and EE.ResultsParticipants comprised 45 in the SCI group and 21 in the able-bodied group. The mean energy expenditure per metre (EE/m) for the SCI participants was 0.33 (± 0.29) calories compared to 0.08 (± 0.02) calories for the able-bodied participants. A decrease in walking velocity resulted in an increase in EE. For SCI participants, every decrease in degree of hip flexion ROM resulted in a 0.003 increase in EE/m walked. A unit decrease in velocity resulted in an increase of 0.41 in EE/m walked. Energy expenditure per metre decreased from ASIA A to ASIA D. Crutch walking utilised 0.34 calories per metre less energy than walking frames (p = 0.03).ConclusionBased on this study’s findings, factors to consider in order to maximise energy efficiency whilst walking are maintaining hip flexion ROM and optimising velocity of walking.
Highlights
In the field of spinal cord injury (SCI) research there is an emphasis on ability to ambulate as a functional outcome (Jackson et al 2008)
When energy expenditure (EE) during orthotic-assisted gait is compared to able-bodied individuals, as expected, the energy cost is far higher during orthotic gait (Kawashima et al 2006)
The purpose of this study was to determine ambulation EE and establish factors that affect ambulation EE in SCI participants compared to able-bodied participants
Summary
In the field of spinal cord injury (SCI) research there is an emphasis on ability to ambulate as a functional outcome (Jackson et al 2008). In people with SCI, gait patterns are significantly altered because of decreased strength, endurance, proprioception and spasticity (Jackson et al 2008) These impairments may result in the use of orthotic devices which can increase energy demands (Field-Fote & Fluet 2001). When energy expenditure (EE) during orthotic-assisted gait is compared to able-bodied individuals, as expected, the energy cost is far higher during orthotic gait (Kawashima et al 2006) Another factor that would impact walking efficiency is the level of neurological impairment. Purpose: To determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants
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