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Butler Forslund E, Truong MTN, Wang R, Seiger Å, Gutierrez-Farewik EM. A Protocol for Comprehensive Analysis of Gait in Individuals with Incomplete Spinal Cord Injury. Methods Protoc 2024; 7:39. [PMID: 38804333 PMCID: PMC11130903 DOI: 10.3390/mps7030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden's largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.
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Affiliation(s)
- Emelie Butler Forslund
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Minh Tat Nhat Truong
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Ruoli Wang
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Åke Seiger
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Elena M. Gutierrez-Farewik
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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Hosseinzadeh Z, Ardakani MK, Minoonejad H. A systematic review of validity and reliability assessment of measuring balance and walking at the level of International Classification of Functioning, Disability and Health (ICF) in people with spinal cord injury. J Spinal Cord Med 2024:1-11. [PMID: 38652087 DOI: 10.1080/10790268.2024.2335413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
CONTEXT A spinal cord injury (SCI) is associated with a wide range of impairments in functioning, many limitations in activity, and restrictions for patients. OBJECTIVES The present study aimed to systematically review the psychometric properties (reliability and validity) of outcome measures used to assess walking and balance in people with spinal cord injury. METHODS Databases such as PubMed, Embase, Scopus, and Web of Sciences were searched for relevant articles using various terms (title and abstract). Articles including the outcome measures of spinal cord injury patients and published in English from 2010 until 2021 were selected, and the quality of the selected studies was determined by applying the COSMIN checklist. Reliability and validity values were extracted, and conclusions were drawn about the psychometric quality of each measure. RESULTS A total of 1253 records were retrieved, and among them 22 potentially eligible articles were identified, 15 of which were included in the present study. The COSMIN tool (Consensus-based Standards for the selection of health status Measurement Instruments) was used to evaluate the quality level of imported articles based on the inclusion criteria. CONCLUSIONS One consideration for testing people with disabilities is to observe the reliability and validity of the instrument, which was addressed in this study in various fields. In our study, seven tools for assessing SCI were evaluated, and it was found that the 10-meter walk (10MWT) tool performs better and more easily than other tools. The Mini-BESTest tool was suggested as a reliable tool for assessing standing balance in SCI subjects.
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Affiliation(s)
- Zahra Hosseinzadeh
- Department of health and sport medicine, Faculty of physical education and sport science, university of Tehran, Tehran, Iran
| | - Mohammad Karimizadeh Ardakani
- Department of health and sport medicine, Faculty of Physical Education and Sports Sciences, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of health and sport medicine, Faculty of Physical Education and Sports Sciences, University of Tehran, Tehran, Iran
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Ros C, José-López R, Font C, Suñol A, Alcoverro E, Nessler J, García de Carellán Mateo A, Aige V, Gonçalves R. Clinical signs, causes, and outcome of central cord syndrome in 22 cats. J Am Vet Med Assoc 2024; 262:405-410. [PMID: 38056077 DOI: 10.2460/javma.23.08.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To describe the signalment, clinical findings, presumptive or definitive diagnosis, and outcome in cats with central cord syndrome (CCS). ANIMALS 22 cats. CLINICAL PRESENTATION Cats evaluated for CCS at 7 referral hospitals between 2017 and 2021 were included. Information retrieved from medical records included signalment, physical and neurological examination findings, diagnostic investigations, definitive or presumptive diagnosis, treatment, and follow-up. RESULTS Median age at presentation was 9 years. Two neuroanatomical localizations were associated with CCS: C1-C5 spinal cord segments in 17 (77.3%) cats and C6-T2 spinal cord segments in 5 (22.7%) cats. Neuroanatomical localization did not correlate with lesion location on MRI in 8 (36.3%) cats. The most common lesion location within the vertebral column was over the C2 and C4 vertebral bodies in 6 (27.2%) and 5 (22.7%) cats, respectively. Peracute clinical signs were observed in 11 (50%) cats, acute in 1 (4.5%), subacute in 4 (18%), and chronic and progressive signs were seen in 6 (40.9%) cats. The most common peracute condition was ischemic myelopathy in 8 (36.3%) cats, whereas neoplasia was the most frequently identified chronic etiology occurring in 5 (22.7%) cats. Outcome was poor in 13 (59%) cats, consisting of 4 of 11 (36.6%) of the peracute cases, 3 of 4 (75%) of the subacute cases, and 6 of 6 of the chronic cases. CLINICAL RELEVANCE Central cord syndrome can occur in cats with lesions in the C1-C5 and C6-T2 spinal cord segments. Multiple etiologies can cause CCS, most commonly, ischemic myelopathy and neoplasia. Prognosis depends on the etiology and onset of clinical signs.
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Affiliation(s)
- Carlos Ros
- 1Neurology and Neurosurgery Service, Memvet Referral Center, Palma de Mallorca, Spain
| | - Roberto José-López
- 2Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Scotland
| | | | - Anna Suñol
- 4Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Scotland
| | | | - Jasmin Nessler
- 6Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Vicente Aige
- 8Departamento de Sanidad y Anatomía Animal, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Rita Gonçalves
- 9Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
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Wouda MF, Løtveit MF, Bengtson EI, Strøm V. The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury. Spinal Cord Ser Cases 2024; 10:7. [PMID: 38418466 PMCID: PMC10902359 DOI: 10.1038/s41394-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI). SETTING Sunnaas Rehabilitation Hospital, Norway. METHODS Thirteen men and two women with iSCI and 15 healthy, matched controls were included. Performance of the Berg Balance Scale (BBS) short version (7 items) was used to indicate balance control. Maximal voluntary contraction (MVC) was performed to measure isometric muscle strength in thigh muscles (knee extension/flexion), while surface electromyography (EMG) was measured from M. Vastus Lateralis and M. Biceps Femoris. The relative activation of each muscle during each of the BBS tasks was reported as the percentage of the maximal activation during the MVC (%EMGmax). RESULTS The iSCI participants had a significantly lower BBS sum score and up to 40% lower muscle strength in knee- flexion and extension compared to the matched healthy controls. They also exhibited a significantly higher %EMGmax, i.e. a higher muscle activation, during most of the balance tests. Univariate regression analysis revealed a significant association between balance control and mean values of %EMGmax in Biceps Femoris, averaged over the seven BBS tests. CONCLUSIONS The participants with iSCI had poorer balance control, reduced thigh muscle strength and a higher relative muscle activation in their thigh muscles, during balance-demanding activities.
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Affiliation(s)
- Matthijs Ferdinand Wouda
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
| | - Marte Fosvold Løtveit
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Alashram AR. Effects of robotic therapy associated with noninvasive brain stimulation on motor function in individuals with incomplete spinal cord injury: A systematic review of randomized controlled trials. J Spinal Cord Med 2024:1-16. [PMID: 38265422 DOI: 10.1080/10790268.2024.2304921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CONTEXT Motor deficits are among the most common consequences of incomplete spinal cord injury (SCI). These impairments can affect patients' levels of functioning and quality of life. Combined robotic therapy and non-invasive brain stimulation (NIBS) have been used to improve motor impairments in patients with corticospinal tract lesions. OBJECTIVES To examine the effects of combined robotic therapy and NIBS on motor function post incomplete SCI. METHODS PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, CINAHL, and EMBASE were searched from inception until July 2023. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the selected studies quality. RESULTS Of 557 studies, five randomized trials (n = 122), with 25% of participants being females, were included in this review. The PEDro scores ranged from eight to nine, with a median score of nine. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The findings showed revealed evidence for the impacts of combined robotic therapy and NIBS on motor function in individuals with incomplete SCI. CONCLUSIONS Combined robotic training and NIBS may be safe for individuals with incomplete SCI. The existing evidence concerning its effects on motor outcomes in individuals with SCI is limited. Further experimental studies are needed to understand the effects of combined robotic training and NIBS on motor impairments in SCI populations.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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Kifley A, Geraghty TJ, Arora M, Bourke J, Craig A, Cameron ID, Nunn A, Marshall R, Middleton JW. Complex lived experiences and hidden disability after spinal cord injury: a latent profile analysis of the Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey. Disabil Rehabil 2023:1-12. [PMID: 38018422 DOI: 10.1080/09638288.2023.2283101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To identify and examine subgroups of people with spinal cord injury (SCI) with different patterns of lived experience, and examine hidden impairments and disability among functionally independent and ambulant people. MATERIALS AND METHODS Latent profile analysis of population-based data from the Australian arm of the International Spinal Cord Injury (InSCI) Community survey (n = 1579). RESULTS Latent subgroups reflected levels of functional independence and extent of problems with health, activity/participation, environmental barriers, and self-efficacy. Quality of life (QoL), psychological profiles, and activity/participation were often as good or better in participants who reported lower (vs. higher) functional independence alongside comparable burden of health problems and environmental barriers. QoL, mental health, and vitality reflected self-efficacy and problem burdens more closely than functional independence. Ambulant participants reported a substantial burden of underlying, potentially hidden impairments, with QoL and mental health similar to wheelchair users. CONCLUSION Hidden disability among more independent and/or ambulant people with SCI can affect well-being substantially. Early and ongoing access to support, rehabilitation, and SCI specialist services is important irrespective of cause, type, severity of injury, and level of functional independence. Improved access to SCI expertise and equity of care would help to improve early recognition and management of hidden disability. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Annette Kifley
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Timothy J Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Australia
- The Hopkins Centre, Metro South Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - John Bourke
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Burwood Academy Trust, Christchurch, New Zealand
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- State Spinal Cord Injury Service, Agency for Clinical Innovation, St Leonards, Australia
- Spinal Outreach Service, Royal Rehab, Ryde, Australia
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Sinovas-Alonso I, Herrera-Valenzuela D, de-Los-Reyes-Guzmán A, Cano-de-la-Cuerda R, Del-Ama AJ, Gil-Agudo Á. Construct Validity of the Gait Deviation Index for People With Incomplete Spinal Cord Injury (GDI-SCI). Neurorehabil Neural Repair 2023; 37:705-715. [PMID: 37864467 DOI: 10.1177/15459683231206747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND The Gait Deviation Index for Spinal Cord Injury (SCI-GDI) was recently proposed as a dimensionless multivariate kinematic measure based on 21 gait features derived from 3-dimensional kinematic data which quantifies gait impairment of adult population with incomplete spinal cord injury (iSCI) relative to the normative gait of a healthy group. Nevertheless, no validity studies of the SCI-GDI have been published to date. OBJECTIVE To assess the construct validity of the SCI-GDI in adult population following iSCI. Methods. SCI-GDI data were obtained from a sample of 50 healthy volunteers and 35 adults with iSCI. iSCI group was also assessed with the following measures: 10-Meter Walk Test (10MWT) at both self-selected (SS) and maximum speeds, Timed Up and Go Test (TUGT), SS and maximum levels of the Walking Index for Spinal Cord Injury (WISCI) II, mobility items of the Spinal Cord Independence Measure III (SCIM IIIIOMob), Lower Extremity Motor Score (LEMS), and Modified Ashworth Scale (MAS). Spearman's correlation coefficient was used to investigate the relationship with the SCI-GDI. RESULTS SCI-GDI shows strong correlation with the 10MWT (r ≥ -.716) and good correlation with LEMS (r = .638), TUGT (r = -.582), SS WISCI II levels (r = .521), and SCIM IIIIOMob (r = .501). No significant correlations were found with maximum WISCI II levels and MAS (P > .006). CONCLUSIONS Construct validity of the SCI-GDI was demonstrated with the 10MWT, TUGT, LEMS, SCIM IIIIOMob, and SS WISCI II levels for independently walking adults with iSCI. Future work will include assessing the psychometric characteristics with a more heterogeneous sample, also considering the pediatric population.
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Affiliation(s)
- Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Diana Herrera-Valenzuela
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Ana de-Los-Reyes-Guzmán
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Movement Analysis, Biomechanics, Ergonomics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Antonio J Del-Ama
- Department of Applied Mathematics, Materials Science and Engineering, and Electronic Technology, School of Science and Technology, Rey Juan Carlos University, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
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Singh G, Rao V, Thamba A, Pahwa B, Zaazoue M. Spine Injuries in Household Environments: A Comprehensive Analysis. Cureus 2023; 15:e44275. [PMID: 37645670 PMCID: PMC10462396 DOI: 10.7759/cureus.44275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.
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Affiliation(s)
- Gurbinder Singh
- Department of Orthopaedic Surgery, University of California-San Francisco School of Medicine, San Francisco, USA
| | - Varun Rao
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Aish Thamba
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bhavya Pahwa
- Medical School, University College of Medical Sciences, New Delhi, Delhi, IND
| | - Mohamed Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
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Kröger I, Wackerle H, Maier D, Mach O, Augat P. [Movement analysis in spinal cord injuries : Assistance in clinical decision making]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04409-y. [PMID: 37490136 PMCID: PMC10400683 DOI: 10.1007/s00132-023-04409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
For motor incomplete spinal cord injured patients, improvement of walking function is an important aim in the rehabilitation program. In specialized treatment centers, the 6‑minute walking test, the 10-meter walking test or the timed-up-and-go test are used as an assessment tool to determine walking ability, but these tests are not able to assess the quality of gait. Marker-based movement analysis can be used as a reliable method to evaluate the gait pattern. This allows an objective assessment of gait quality over time or can be used to support therapy planning. The benefit of such an analysis is presented by means of two case studies.
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Affiliation(s)
- Inga Kröger
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland.
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
| | - Hannes Wackerle
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Doris Maier
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Orpheus Mach
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Peter Augat
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
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Lora-Millan JS, Nabipour M, van Asseldonk E, Bayón C. Advances on mechanical designs for assistive ankle-foot orthoses. Front Bioeng Biotechnol 2023; 11:1188685. [PMID: 37485319 PMCID: PMC10361304 DOI: 10.3389/fbioe.2023.1188685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
Assistive ankle-foot orthoses (AAFOs) are powerful solutions to assist or rehabilitate gait on humans. Existing AAFO technologies include passive, quasi-passive, and active principles to provide assistance to the users, and their mechanical configuration and control depend on the eventual support they aim for within the gait pattern. In this research we analyze the state-of-the-art of AAFO and classify the different approaches into clusters, describing their basis and working principles. Additionally, we reviewed the purpose and experimental validation of the devices, providing the reader with a better view of the technology readiness level. Finally, the reviewed designs, limitations, and future steps in the field are summarized and discussed.
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Affiliation(s)
| | - Mahdi Nabipour
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Edwin van Asseldonk
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Cristina Bayón
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
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Dusane S, Shafer A, Ochs WL, Cornwell T, Henderson H, Kim KYA, Gordon KE. Control of center of mass motion during walking correlates with gait and balance in people with incomplete spinal cord injury. Front Neurol 2023; 14:1146094. [PMID: 37325225 PMCID: PMC10262050 DOI: 10.3389/fneur.2023.1146094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background There is evidence that ambulatory people with incomplete spinal cord injury (iSCI) have an impaired ability to control lateral motion of their whole-body center of mass (COM) during walking. This impairment is believed to contribute to functional deficits in gait and balance, however that relationship is unclear. Thus, this cross-sectional study examines the relationship between the ability to control lateral COM motion during walking and functional measures of gait and balance in people with iSCI. Methods We assessed the ability to control lateral COM motion during walking and conducted clinical gait and balance outcome measures on 20 ambulatory adults with chronic iSCI (C1-T10 injury, American Spinal Injury Association Impairment Scale C or D). To assess their ability to control lateral COM motion, participants performed three treadmill walking trials. During each trial, real-time lateral COM position and a target lane were projected on the treadmill. Participants were instructed to keep their lateral COM position within the lane. If successful, an automated control algorithm progressively reduced the lane width, making the task more challenging. If unsuccessful, the lane width increased. The adaptive lane width was designed to challenge each participant's maximum capacity to control lateral COM motion during walking. To quantify control of lateral COM motion, we calculated lateral COM excursion during each gait cycle and then identified the minimum lateral COM excursion occurring during five consecutive gait cycles. Our clinical outcome measures were Berg Balance Scale (BBS), Timed Up and Go test (TUG), 10-Meter Walk Test (10MWT) and Functional Gait Assessment (FGA). We used a Spearman correlation analysis (ρ) to examine the relationship between minimum lateral COM excursion and clinical measures. Results Minimum lateral COM excursion had significant moderate correlations with BBS (ρ = -0.54, p = 0.014), TUG (ρ = 0.59, p = 0.007), FGA (ρ = -0.59, p = 0.007), 10MWT-preferred (ρ = -0.59, p = 0.006) and 10MWT-fast (ρ = -0.68, p = 0.001). Conclusion Control of lateral COM motion during walking is associated with a wide range of clinical gait and balance measures in people with iSCI. This finding suggests the ability to control lateral COM motion during walking could be a contributing factor to gait and balance in people with iSCI.
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Affiliation(s)
- Shamali Dusane
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Anna Shafer
- Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Wendy L. Ochs
- Edward Hines Jr. VA Hospital, Hines, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Tara Cornwell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Heather Henderson
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Keith E. Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Edward Hines Jr. VA Hospital, Hines, IL, United States
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12
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Werner C, Gönel M, Lerch I, Curt A, Demkó L. Data-driven characterization of walking after a spinal cord injury using inertial sensors. J Neuroeng Rehabil 2023; 20:55. [PMID: 37120519 PMCID: PMC10149024 DOI: 10.1186/s12984-023-01178-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/19/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND An incomplete spinal cord injury (SCI) refers to remaining sensorimotor function below the injury with the possibility for the patient to regain walking abilities. However, these patients often suffer from diverse gait deficits, which are not objectively assessed in the current clinical routine. Wearable inertial sensors are a promising tool to capture gait patterns objectively and started to gain ground for other neurological disorders such as stroke, multiple sclerosis, and Parkinson's disease. In this work, we present a data-driven approach to assess walking for SCI patients based on sensor-derived outcome measures. We aimed to (i) characterize their walking pattern in more depth by identifying groups with similar walking characteristics and (ii) use sensor-derived gait parameters as predictors for future walking capacity. METHODS The dataset analyzed consisted of 66 SCI patients and 20 healthy controls performing a standardized gait test, namely the 6-min walking test (6MWT), while wearing a sparse sensor setup of one sensor attached to each ankle. A data-driven approach has been followed using statistical methods and machine learning models to identify relevant and non-redundant gait parameters. RESULTS Clustering resulted in 4 groups of patients that were compared to each other and to the healthy controls. The clusters did differ in terms of their average walking speed but also in terms of more qualitative gait parameters such as variability or parameters indicating compensatory movements. Further, using longitudinal data from a subset of patients that performed the 6MWT several times during their rehabilitation, a prediction model has been trained to estimate whether the patient's walking speed will improve significantly in the future. Including sensor-derived gait parameters as inputs for the prediction model resulted in an accuracy of 80%, which is a considerable improvement of 10% compared to using only the days since injury, the present 6MWT distance, and the days until the next 6MWT as predictors. CONCLUSIONS In summary, the work presented proves that sensor-derived gait parameters provide additional information on walking characteristics and thus are beneficial to complement clinical walking assessments of SCI patients. This work is a step towards a more deficit-oriented therapy and paves the way for better rehabilitation outcome predictions.
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Affiliation(s)
- Charlotte Werner
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland.
| | - Meltem Gönel
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Irina Lerch
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - László Demkó
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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13
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Leon Machado L, Lucas K, Behrman AL. Activity-Based Restorative Therapy Promotes Progression from Asymmetry to Symmetry in Posture and Gait in a Child with Chronic, Incomplete Spinal Cord Injury. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030594. [PMID: 36980152 PMCID: PMC10047088 DOI: 10.3390/children10030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Incomplete spinal cord injuries (ISCI) in pediatrics and adults can lead to asymmetric motor impairments exhibiting as asymmetries of posture and gait. Recently, rehabilitation guidelines for adults with neurologic injuries have focused on gaining a functional gait pattern as measured by speed and distance, even if asymmetry deficits persist. Activity-based restorative therapies (ABRT) take advantage of activity-dependent neuroplasticity to change an individual's neuromuscular capacity. This is a report of an ambulatory child with chronic ISCI presenting with significant postural and gait asymmetries who enrolled in an ABRT program. Across 79 ABRT sessions, the child gained symmetry during sitting, standing, and walking. Even though this child was a functional ambulator at enrollment, targeting symmetry of movements via improved neuromuscular capacity further enhanced her achievement of kinematically appropriate function for participation in daily activities.
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Affiliation(s)
- Laura Leon Machado
- Frazier Rehabilitation Institute, UofL Health, Louisville, KY 40202, USA
| | - Kathryn Lucas
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
| | - Andrea L Behrman
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
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14
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Zwijgers E, van Asseldonk EHF, Vos-van der Hulst M, Geurts ACH, Keijsers NLW. Impaired foot placement strategy during walking in people with incomplete spinal cord injury. J Neuroeng Rehabil 2022; 19:134. [PMID: 36471441 PMCID: PMC9720963 DOI: 10.1186/s12984-022-01117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Impaired balance during walking is a common problem in people with incomplete spinal cord injury (iSCI). To improve walking capacity, it is crucial to characterize balance control and how it is affected in this population. The foot placement strategy, a dominant mechanism to maintain balance in the mediolateral (ML) direction during walking, can be affected in people with iSCI due to impaired sensorimotor control. This study aimed to determine if the ML foot placement strategy is impaired in people with iSCI compared to healthy controls. METHODS People with iSCI (n = 28) and healthy controls (n = 19) performed a two-minute walk test at a self-paced walking speed on an instrumented treadmill. Healthy controls performed one extra test at a fixed speed set at 50% of their preferred speed. To study the foot placement strategy of a participant, linear regression was used to predict the ML foot placement based on the ML center of mass position and velocity. The accuracy of the foot placement strategy was evaluated by the root mean square error between the predicted and actual foot placements and was referred to as foot placement deviation. Independent t-tests were performed to compare foot placement deviation of people with iSCI versus healthy controls walking at two different walking speeds. RESULTS Foot placement deviation was significantly higher in people with iSCI compared to healthy controls independent of walking speed. Participants with iSCI walking in the self-paced condition exhibited 0.40 cm (51%) and 0.33 cm (38%) higher foot placement deviation compared to healthy controls walking in the self-paced and the fixed-speed 50% condition, respectively. CONCLUSIONS Higher foot placement deviation in people with iSCI indicates an impaired ML foot placement strategy in individuals with iSCI compared to healthy controls.
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Affiliation(s)
- Eline Zwijgers
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Edwin H. F. van Asseldonk
- grid.6214.10000 0004 0399 8953Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Marije Vos-van der Hulst
- grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- grid.10417.330000 0004 0444 9382Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.452818.20000 0004 0444 9307Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands ,grid.5590.90000000122931605Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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15
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Lecomte CG, Mari S, Audet J, Merlet AN, Harnie J, Beaulieu C, Abdallah K, Gendron L, Rybak IA, Prilutsky BI, Frigon A. Modulation of the gait pattern during split-belt locomotion after lateral spinal cord hemisection in adult cats. J Neurophysiol 2022; 128:1593-1616. [PMID: 36382895 PMCID: PMC9744650 DOI: 10.1152/jn.00230.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Most previous studies investigated the recovery of locomotion in animals and people with incomplete spinal cord injury (SCI) during relatively simple tasks (e.g., walking in a straight line on a horizontal surface or a treadmill). We know less about the recovery of locomotion after incomplete SCI in left-right asymmetric conditions, such as turning or stepping along circular trajectories. To investigate this, we collected kinematic and electromyography data during split-belt locomotion at different left-right speed differences before and after a right thoracic lateral spinal cord hemisection in nine adult cats. After hemisection, although cats still performed split-belt locomotion, we observed several changes in the gait pattern compared with the intact state at early (1-2 wk) and late (7-8 wk) time points. Cats with larger lesions showed new coordination patterns between the fore- and hindlimbs, with the forelimbs taking more steps. Despite this change in fore-hind coordination, cats maintained consistent phasing between the fore- and hindlimbs. Adjustments in cycle and phase (stance and swing) durations between the slow and fast sides allowed animals to maintain 1:1 left-right coordination. Periods of triple support involving the right (ipsilesional) hindlimb decreased in favor of quad support and triple support involving the other limbs. Step and stride lengths decreased with concurrent changes in the right fore- and hindlimbs, possibly to avoid interference. The above adjustments in the gait pattern allowed cats to retain the ability to locomote in asymmetric conditions after incomplete SCI. We discuss potential plastic neuromechanical mechanisms involved in locomotor recovery in these conditions.NEW & NOTEWORTHY Everyday locomotion often involves left-right asymmetries, when turning, walking along circular paths, stepping on uneven terrains, etc. To show how incomplete spinal cord injury affects locomotor control in asymmetric conditions, we collected data before and after a thoracic lateral spinal hemisection on a split-belt treadmill with one side stepping faster than the other. We show that adjustments in kinematics and muscle activity allowed cats to retain the ability to perform asymmetric locomotion after hemisection.
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Affiliation(s)
- Charly G Lecomte
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Stephen Mari
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Johannie Audet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Angèle N Merlet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jonathan Harnie
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Claudie Beaulieu
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Khaled Abdallah
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Gendron
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ilya A Rybak
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Boris I Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia
| | - Alain Frigon
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Lorusso M, Tagliamonte NL, Tramontano M, Fresch A, Granelli G, Smania N, Tamburella F. Technology-assisted balance assessment and rehabilitation in individuals with spinal cord injury: A systematic review. NeuroRehabilitation 2022; 51:213-230. [DOI: 10.3233/nre-220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Balance is a crucial function of basic Activities of Daily Living (ADL) and is often considered the priority in Spinal Cord Injury (SCI) patients’ rehabilitation. Technological devices have been developed to support balance assessment and training, ensuring an earlier, intensive, and goal-oriented motor therapy. OBJECTIVE: The aim of this systematic review is to explore the technology-assisted strategies to assess and rehabilitate balance function in persons with SCI. METHODS: A systematic review was conducted in the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and Embase. Full reports on Randomized Clinical Trials (RCTs) of parallel-group or cross-over design and non-RCTs were included according to the following criteria: i) publication year from 1990 to 2021; ii) balance considered as a primary or secondary outcome; iii) population of individuals with SCI with age over 18 years old, regardless of traumatic or non-traumatic lesions, Time Since Injury, lesion level, Asia Impairment Scale score and gender. The methodological quality was determined for each included study according to the recognized Downs and Black (D&B) tool. RESULTS: Nineteen articles met the inclusion criteria and were included in the analysis. Four articles focused on balance assessment while 15 targeted rehabilitation interventions to improve balance by using Treadmill-Based Devices (TBD), OverGround Devices (OGD) and Tilt Table Devices (TTD). Statistically significant effects on balance can be found in TBD subcategory, in the hip-knee guidance subcategory of OGD and in the study of TTD category. CONCLUSION: Although different studies reported positive effects, improvements due to technology-assisted rehabilitation were not greater than those obtained by means of other rehabilitation therapies. The heterogeneity, low methodological quality, and the small number of the studies included do not allow general conclusions about the usefulness of technology-assisted balance assessment and training in individuals with SCI, even if significant improvements have been reported in some studies.
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Affiliation(s)
| | | | - Marco Tramontano
- IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Anna Fresch
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Giulia Granelli
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
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Mohammadzada F, Zipser CM, Easthope CA, Halliday DM, Conway BA, Curt A, Schubert M. Mind your step: Target walking task reveals gait disturbance in individuals with incomplete spinal cord injury. J Neuroeng Rehabil 2022; 19:36. [PMID: 35337335 PMCID: PMC8957135 DOI: 10.1186/s12984-022-01013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Walking over obstacles requires precise foot placement while maintaining balance control of the center of mass (CoM) and the flexibility to adapt the gait patterns. Most individuals with incomplete spinal cord injury (iSCI) are capable of overground walking on level ground; however, gait stability and adaptation may be compromised. CoM control was investigated during a challenging target walking (TW) task in individuals with iSCI compared to healthy controls. The hypothesis was that individuals with iSCI, when challenged with TW, show a lack of gait pattern adaptability which is reflected by an impaired adaptation of CoM movement compared to healthy controls. Methods A single-center controlled diagnostic clinical trial with thirteen participants with iSCI (0.3–24 years post injury; one subacute and twelve chronic) and twelve healthy controls was conducted where foot and pelvis kinematics were acquired during two conditions: normal treadmill walking (NW) and visually guided target walking (TW) with handrail support, during which participants stepped onto projected virtual targets synchronized with the moving treadmill surface. Approximated CoM was calculated from pelvis markers and used to calculate CoM trajectory length and mean CoM Euclidean distance TW-NW (primary outcome). Nonparametric statistics, including spearman rank correlations, were performed to evaluate the relationship between clinical parameter, outdoor mobility score, performance, and CoM parameters (secondary outcome). Results Healthy controls adapted to TW by decreasing anterior–posterior and vertical CoM trajectory length (p < 0.001), whereas participants with iSCI reduced CoM trajectory length only in the vertical direction (p = 0.002). Mean CoM Euclidean distance TW-NW correlated with participants’ neurological level of injury (R = 0.76, p = 0.002) and CoM trajectory length (during TW) correlated with outdoor mobility score (R = − 0.64, p = 0.026). Conclusions This study demonstrated that reduction of CoM movement is a common strategy to cope with TW challenge in controls, but it is impaired in individuals with iSCI. In the iSCI group, the ability to cope with gait challenges worsened the more rostral the level of injury. Thus, the TW task could be used as a gait challenge paradigm in ambulatory iSCI individuals. Trial registration Registry number/ ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01013-7.
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Affiliation(s)
- Freschta Mohammadzada
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Chris A Easthope
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.,Cereneo Foundation, Center for Interdisciplinary Research, 6354, Vitznau, Switzerland
| | - David M Halliday
- Department of Electronic Engineering, University of York, York, YO10 5DD, UK.,York Biomedical Research Institute, University of York, York, UK
| | - Bernard A Conway
- Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - Armin Curt
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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18
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Increased risk of sensorineural hearing loss in patients with spinal cord injury: a nationwide longitudinal follow-up study. Spinal Cord 2021; 59:1200-1205. [PMID: 34417551 DOI: 10.1038/s41393-021-00697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study with 10 years follow-up. OBJECTIVE To compare the risks of sensorineural hearing loss in patients with and without spinal cord injury, based on a nationally representative sample. SETTING Taiwan's Longitudinal Health Insurance Database 2005. METHOD A total of 2006 participants who had been aged between 20 and 69 and who had spinal cord injury as of 2002-06 were enrolled in the spinal cord injury group. The non-spinal cord injury group consisted of 8024 sex- and age-matched, randomly sampled participants without spinal cord injury. Then, their sensorineural hearing loss -cumulative incidence curves were generated using the Kaplan-Meier method. Stratified Cox proportional-hazard regression was employed to estimate the effect of having spinal cord injury on patients' subsequent risk of sensorineural hearing loss. RESULTS During the follow-up, 30 patients in the spinal cord injury group and 87 in the non-spinal cord injury group developed sensorineural hearing loss. As such, the cumulative incidence of sensorineural hearing loss was significantly higher in the spinal cord injury group than the non-spinal cord injury group (2.16 vs. 1.21 per 1000 person-years, p = 0.008). The adjusted hazard ratio of sensorineural hearing loss for the spinal cord injury group was 1.75 times that of the non-spinal cord injury group (95% CI, 1.14-2.68, p = 0.01). The patients with non-cervical SCI appeared to have a higher magnitude of SNHL risk than their cervical SCI counterparts. CONCLUSION Our study showed that patients with spinal cord injury have an increased risk of developing sensorineural hearing loss.
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Park JH, Kim HS, Jang SH, Hyun DJ, Park SI, Yoon J, Lim H, Kim MJ. Cardiorespiratory Responses to 10 Weeks of Exoskeleton-Assisted Overground Walking Training in Chronic Nonambulatory Patients with Spinal Cord Injury. SENSORS 2021; 21:s21155022. [PMID: 34372258 PMCID: PMC8347087 DOI: 10.3390/s21155022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022]
Abstract
Exercise intensity of exoskeleton-assisted walking in patients with spinal cord injury (SCI) has been reported as moderate. However, the cardiorespiratory responses to long-term exoskeleton-assisted walking have not been sufficiently investigated. We investigated the cardiorespiratory responses to 10 weeks of exoskeleton-assisted walking training in patients with SCI. Chronic nonambulatory patients with SCI were recruited from an outpatient clinic. Walking training with an exoskeleton was conducted three times per week for 10 weeks. Oxygen consumption and heart rate (HR) were measured during a 6-min walking test at pre-, mid-, and post-training. Exercise intensity was determined according to the metabolic equivalent of tasks (METs) for SCI and HR relative to the HR reserve (%HRR). Walking efficiency was calculated as oxygen consumption divided by walking speed. The exercise intensity according to the METs (both peak and average) corresponded to moderate physical activity and did not change after training. The %HRR demonstrated a moderate (peak %HRR) and light (average %HRR) exercise intensity level, and the average %HRR significantly decreased at post-training compared with mid-training (31.6 ± 8.9% to 24.3 ± 7.3%, p = 0.013). Walking efficiency progressively improved after training. Walking with an exoskeleton for 10 weeks may affect the cardiorespiratory system in chronic patients with SCI.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri-si 11923, Korea; (J.H.P.); (S.H.J.)
| | - Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
| | - Seong Ho Jang
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri-si 11923, Korea; (J.H.P.); (S.H.J.)
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
| | - Dong Jin Hyun
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Sang In Park
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - JuYoung Yoon
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Hyunseop Lim
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
- Correspondence: ; Tel.: +82-2-2290-9353
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20
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Calabrò RS, Billeri L, Ciappina F, Balletta T, Porcari B, Cannavò A, Pignolo L, Manuli A, Naro A. Toward improving functional recovery in spinal cord injury using robotics: a pilot study focusing on ankle rehabilitation. Expert Rev Med Devices 2021; 19:83-95. [PMID: 33616471 DOI: 10.1080/17434440.2021.1894125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Conventional physical therapy interventions are strongly recommended to improve ambulation potential and upright mobility in persons with incomplete spinal cord injury (iSCI). Ankle rehabilitation plays a significant role, as it aims to stem drop foot consequences.Research question: This pilot study aimed to assess the neurophysiological underpinnings of robot-aided ankle rehabilitation (using a platform robot) compared to conventional physiotherapy and its efficacy in improving gait performance and balance in persons with iSCI.Methods: Ten individuals with subacute/chronic iSCI (six males and four females, 39 ± 13 years, time since injury 8 ± 4 months, ASIA impairment scale grade C-D) were provided with one-month intensive training for robot-aided ankle rehabilitation (24 sessions, 1 h daily, six times a week). Clinical (10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Timed Up and Go test (TUG)), and electrophysiological aftereffects (surface-EMG from tibialis anterior and medial gastrocnemius muscles to estimate muscle activation patterns; and corticomuscular coherence-CMC-to assess functional synchronization between sensorimotor cortex and muscles, i.e. the functional integrity of corticospinal output) were assessed at baseline (PRE) and after the trial completion (POST). The experimental group (EG) data were compared with those coming from a retrospective control group (CG; n = 10) matched for clinical-demographic characteristics, who previously underwent conventional ankle rehabilitation.Results: the EG achieved a greater improvement in balance and gait as compared to the CG (TUG EG from 70 ± 18 to 45 ± 15 s, p = 0.002; CG from 68 ± 21 to 48 ± 18 s, p = 0.01; group-comparison p = 0.001; 10MWT EG from 0.43 ± 0.11 to 0.51 ± 0.09 m/s, p = 0.006; CG from 0.4 ± 0.13 to 0.45 ± 0.12, p = 0.01; group-comparison p = 0.006; 6 MWT EG from 231 ± 13 to 274 ± 15 m, p < 0.001; CG from 236 ± 13 to 262 ± 15 m, p = 0.003; group-comparison p = 0.01). Furthermore, the EG showed a retraining of muscle activation (an increase within proper movements, with a reduction of co-contractions) and CMC (beta frequency increase within proper movements, i.e. in a framework of preserved motor coordination). The improvements in CMC, gait, balance, and muscle activation were not correlated with each other.Conclusions: Robot-aided ankle rehabilitation improved gait performance by selectively ameliorating CMC, muscle activation patterns, and, lastly, gait balance and speed. Despite CMC, gait, balance, and muscle activation were not correlated, this pilot study suggests that robot-aided ankle rehabilitation may favor a better communication between above-SCI and below-SCI structures. This communication improvement may depend on a more synchronized corticospinal output (as per CMC increase) and a better responsiveness of below-SCI motorneurons to corticospinal output (as per specific and ankle movement focused muscle activation increases at the surface EMG), thus favoring greater recruitment of spinal motor units and, ultimately, improving muscle activation pattern and strength.Significance: Adopting robot-aided ankle rehabilitation protocols for persons with iSCI in the subacute/chronic phase may allow achieving a clinically significant improvement in gait performance.
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Affiliation(s)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Bruno Porcari
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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21
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Yang J, Liang R, Wang L, Zheng C, Xiao X, Ming D. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves the Gait Disorders of Rats Under Simulated Microgravity Conditions Associated With the Regulation of Motor Cortex. Front Physiol 2021; 12:587515. [PMID: 33613305 PMCID: PMC7890125 DOI: 10.3389/fphys.2021.587515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
In previous studies, it has been proved that repetitive transcranial magnetic stimulation (rTMS) improves dyskinesia induced by conditions such as spinal cord injury, Parkinson diseases and cerebral ischemia. However, it is still unknown whether it can be used as a countermeasure for gait disorders in astronauts during space flight. In this study, we evaluated the effects of rTMS on the rat gait function under simulated microgravity (SM) conditions. The SM procedure continued for consecutive 21 days in male Wistar rats. Meanwhile, the high-frequency rTMS (10 Hz) was applied for 14 days from the eighth day of SM procedure. The behavioral results showed that SM could cause gait disorders such as decreased walking ability and contralateral limb imbalance in rats, which could be reversed by rTMS. Furthermore, rTMS affected the neural oscillations of motor cortex, enhancing in δ (2–4 Hz) band, suppressing in θ (4–7 Hz), and α (7–12 Hz) bands. Additionally, rTMS could activate mTOR in the motor cortex. These data suggests that the improvement effects of rTMS on gait disorders in rats under SM conditions might be associated with its regulation on neural oscillations in the cerebral motor cortex and the expression of some motor-related proteins which may enhance the control of nervous system on muscle function. Based on our results, rTMS can be used as an potential effective supplement in the field of clinical and rehabilitation research to reduce gait disorders caused by the space environment.
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Affiliation(s)
- Jiajia Yang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Rong Liang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Ling Wang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Chenguang Zheng
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Xi Xiao
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Dong Ming
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
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22
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de Jong LAF, Kerkum YL, de Groot T, Vos-van der Hulst M, van Nes IJW, Keijsers NLW. Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis. SENSORS 2021; 21:s21030985. [PMID: 33540606 PMCID: PMC7867220 DOI: 10.3390/s21030985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022]
Abstract
Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.
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Affiliation(s)
- Lysanne A. F. de Jong
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands; (T.d.G.); (N.L.W.K.)
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 AJ Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-327-2564
| | - Yvette L. Kerkum
- Research and Development, OIM Orthopedie, 9400 AE Assen, The Netherlands;
| | - Tom de Groot
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands; (T.d.G.); (N.L.W.K.)
| | - Marije Vos-van der Hulst
- Department of Rehabilitation, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands; (M.V.-v.d.H.); (I.J.W.v.N.)
| | - Ilse J. W. van Nes
- Department of Rehabilitation, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands; (M.V.-v.d.H.); (I.J.W.v.N.)
| | - Noel L. W. Keijsers
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands; (T.d.G.); (N.L.W.K.)
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 AJ Nijmegen, The Netherlands
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23
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Cao Y, DiPiro ND, Brotherton SS, Krause JS. Assistive devices and future fall-related injuries among ambulatory adults with spinal cord injury: a prospective cohort study. Spinal Cord 2020; 59:747-752. [PMID: 33130822 DOI: 10.1038/s41393-020-00572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study with two times of measurement. OBJECTIVE To assess the relationship between use of assistive devices for walking (at baseline) and the number of annual fall-related injuries (at follow-up) among a cohort of ambulatory adults with spinal cord injury (SCI). SETTING Medical University in the Southeastern United States. METHODS There were 622 ambulatory adults who met the eligibility criteria, 317 of whom completed both baseline and follow-up assessments. The participants completed a mailed self-report assessment (SRA) that measured self-reported number of fall-related injuries in the previous year, and the use of orthopedic equipment (assistive devices) for walking, including cane(s), crutches, walker, and braces, was assessed at both baseline and follow-up. RESULTS The percentage of at least one self-reported fall-related injury decreased from 22% at baseline to 13% at the follow-up. Walker and cane use at baseline was significantly associated with fall-related injuries at follow-up. Participants using one walking device related to 194% greater number of fall injures, and using multiple device related to 730% greater number of fall injures than those who used no devices. We also found walker users were associated with 214% greater number of fall injures, while cane users were associated with 160% greater number of fall injures. CONCLUSIONS The probability of fall-related injury remained high among persons who are ambulatory after SCI. Health care professionals should be aware of the balance between the goal of ambulation and the potential increased risk of fall-related injuries associated with assistive device use.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Sandra S Brotherton
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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24
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International Spinal Cord Injury Physical Therapy-Occupational Therapy Basic Data Set (Version 1.2). Spinal Cord Ser Cases 2020; 6:74. [PMID: 32807768 DOI: 10.1038/s41394-020-00323-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Expert workgroup consensus, focused literature review, and vetting via feedback from international presentations and spinal cord professional membership groups. OBJECTIVES Develop and refine a basic dataset to enable standardized documentation of physical therapy (PT) and occupational therapy (OT) interventions delivered in a controlled clinical trial intended to improve voluntary motor function. SETTING International Expert Working Group. METHODS An international working group with expertise in spinal cord injury, PT, OT, and measurement developed a draft of the International Spinal Cord Injury (ISCI) Physical Therapy-Occupational Therapy (PT-OT) Basic Data Set (BDS). Emphasis was placed on efficiency and practicality of use. The BDS was iteratively refined based on applicable literature, and feedback collected from presentations at the 2017 and 2019 International Spinal Cord Society meetings. RESULTS The ISCI PT-OT BDS contains seven broad categories of interventions: bed/seated mobility, standing activities, walking/stairs, gross motor upper extremity, fine motor upper extremity, strength training, and endurance training. The first five categories are classified as activity-directed and the last two as impairment-directed interventions. Time spent on interventions per category is recorded in 15-min intervals. CONCLUSIONS The ISCI PT-OT BDS enables standardized documentation of PT-OT activity-directed or impairment-directed interventions. The ISCI PT-OT BDS is a documentation tool to facilitate evaluation of the influence of rehabilitation therapies on motor function in clinical trials of biologic or pharmacologic agents or rehabilitation technologies that are delivered in the clinical setting.
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25
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Favier CD, Deane JA, McGregor AH, Phillips ATM. Design and preliminary testing of a low-cost balance perturbation system for the evaluation of real life postural adjustment on public transport. J Med Eng Technol 2019; 43:356-362. [DOI: 10.1080/03091902.2019.1673845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Clément D. Favier
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Janet A. Deane
- Musculoskeletal Lab in the Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alison H. McGregor
- Musculoskeletal Lab in the Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Andrew T. M. Phillips
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
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