1
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Tan AQ, Tuthill C, Corsten AN, Barth S, Trumbower RD. A single sequence of intermittent hypoxia does not alter stretch reflex excitability in able-bodied individuals. Exp Physiol 2024; 109:576-587. [PMID: 38356241 PMCID: PMC10988685 DOI: 10.1113/ep091531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
Spasticity attributable to exaggerated stretch reflex pathways, particularly affecting the ankle plantar flexors, often impairs overground walking in persons with incomplete spinal cord injury. Compelling evidence from rodent models underscores how exposure to acute intermittent hypoxia (AIH) can provide a unique medium to induce spinal plasticity in key inhibitory pathways mediating stretch reflex excitability and potentially affect spasticity. In this study, we quantify the effects of a single exposure to AIH on the stretch reflex in able-bodied individuals. We hypothesized that a single sequence of AIH will increase the stretch reflex excitability of the soleus muscle during ramp-and-hold angular perturbations applied to the ankle joint while participants perform passive and volitionally matched contractions. Our results revealed that a single AIH exposure did not significantly change the stretch reflex excitability during both passive and active matching conditions. Furthermore, we found that able-bodied individuals increased their stretch reflex response from passive to active matching conditions after both sham and AIH exposures. Together, these findings suggest that a single AIH exposure might not engage inhibitory pathways sufficiently to alter stretch reflex responses in able-bodied persons. However, the generalizability of our present findings requires further examination during repetitive exposures to AIH along with potential reflex modulation during functional movements, such as overground walking.
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Affiliation(s)
- Andrew Q. Tan
- Department of Integrative PhysiologyUniversity of ColoradoBoulderColoradoUSA
| | - Christopher Tuthill
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolBostonMassachusettsUSA
- Department of Physical Medicine and RehabilitationINSPIRE LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Anthony N. Corsten
- Department of Physical Medicine and RehabilitationINSPIRE LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Stella Barth
- Department of Physical Medicine and RehabilitationINSPIRE LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Randy D. Trumbower
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolBostonMassachusettsUSA
- Department of Physical Medicine and RehabilitationINSPIRE LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
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2
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Cherni Y, Blache Y, Begon M, Ballaz L, Dal Maso F. Effect of Robotic-Assisted Gait at Different Levels of Guidance and Body Weight Support on Lower Limb Joint Kinematics and Coordination. SENSORS (BASEL, SWITZERLAND) 2023; 23:8800. [PMID: 37960500 PMCID: PMC10650199 DOI: 10.3390/s23218800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
The Lokomat provides task-oriented therapy for patients with gait disorders. This robotic technology drives the lower limbs in the sagittal plane. However, normative gait also involves motions in the coronal and transverse planes. This study aimed to compare the Lokomat with Treadmill gait through three-dimensional (3D)-joint kinematics and inter-joint coordination. Lower limb kinematics was recorded in 18 healthy participants who walked at 3 km/h on a Treadmill or in a Lokomat with nine combinations of Guidance (30%, 50%, 70%) and bodyweight support (30%, 50%, 70%). Compared to the Treadmill, the Lokomat altered pelvic rotation, decreased pelvis obliquity and hip adduction, and increased ankle rotation. Moreover, the Lokomat resulted in significantly slower velocity at the hip, knee, and ankle flexion compared to the treadmill condition. Moderate to strong correlations were observed between the Treadmill and Lokomat conditions in terms of inter-joint coordination between hip-knee (r = 0.67-0.91), hip-ankle (r = 0.66-0.85), and knee-ankle (r = 0.90-0.95). This study showed that some gait determinants, such as pelvis obliquity, rotation, and hip adduction, are altered when walking with Lokomat in comparison to a Treadmill. Kinematic deviations induced by the Lokomat were most prominent at high levels of bodyweight support. Interestingly, different levels of Guidance did not affect gait kinematics. The present results can help therapists to adequately select settings during Lokomat therapy.
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Affiliation(s)
- Yosra Cherni
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
| | - Yoann Blache
- Centre de Recherche et d’Innovation Sur le Sport, Université de Lyon, 69007 Lyon, France
| | - Mickael Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
| | - Laurent Ballaz
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 2C4, Canada
| | - Fabien Dal Maso
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre Interdisciplinaire sur le Cerveau et l’Apprentissage, Université de Montréal, Montréal, QC H3C 3J7, Canada
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3
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Karulkar RM, Wensing PM. Personalized Estimation of Intended Gait Speed for Lower-Limb Exoskeleton Users via Data Augmentation Using Mutual Information. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3191039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Roopak M. Karulkar
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Patrick M. Wensing
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN, USA
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4
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Original article: Validity and reliability of gait metrics derived from researcher-placed and self-placed wearable inertial sensors. J Biomech 2022; 142:111263. [PMID: 36030636 DOI: 10.1016/j.jbiomech.2022.111263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
To compare the inter-session placement reliability for researcher-placed and self-placed sensors, and to evaluate the validity and reliability of waveforms and discrete variables from researcher-placed and self-placed sensors following a previously described alignment correction algorithm. Fourteen healthy, pain-free participants underwent gait analysis over two data collection sessions. Participants self-placed an inertial sensor on their left tibia and a researcher placed one on their right tibia, before completing 10 overground walking trials. Following an axis correction from a principal component analysis-based algorithm, validity and reliability were assessed within and between days for each sensor placement type through Euclidean distances, waveforms, and discrete outcomes. The placement location of researcher-placed sensors exhibited good inter-session reliability (ICC = 0.85) in comparison to self-placed sensors (ICC = 0.55). Similarly, waveforms from researcher-placed sensors exhibited excellent validity across all variables (CMC ≥ 0.90), while self-placed sensors saw high validity for most axes with reductions in validity for mediolateral acceleration and frontal plane angular velocity. Discrete outcomes saw good to excellent reliability across both sensor placement types. A simple alignment correction algorithm for inertial sensor gait data demonstrated good to excellent validity and reliability in self-placed sensors with no additional data or measures. This method can be used to align sensors easily and effectively despite sensor placement errors during straight, level walking to improve 3D gait data outcomes in data collected with self-placed sensors.
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5
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Zipser-Mohammadzada F, Conway BA, Halliday DM, Zipser CM, Easthope CA, Curt A, Schubert M. Intramuscular coherence during challenging walking in incomplete spinal cord injury: Reduced high-frequency coherence reflects impaired supra-spinal control. Front Hum Neurosci 2022; 16:927704. [PMID: 35992941 PMCID: PMC9387543 DOI: 10.3389/fnhum.2022.927704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Individuals regaining reliable day-to-day walking function after incomplete spinal cord injury (iSCI) report persisting unsteadiness when confronted with walking challenges. However, quantifiable measures of walking capacity lack the sensitivity to reveal underlying impairments of supra-spinal locomotor control. This study investigates the relationship between intramuscular coherence and corticospinal dynamic balance control during a visually guided Target walking treadmill task. In thirteen individuals with iSCI and 24 controls, intramuscular coherence and cumulant densities were estimated from pairs of Tibialis anterior surface EMG recordings during normal treadmill walking and a Target walking task. The approximate center of mass was calculated from pelvis markers. Spearman rank correlations were performed to evaluate the relationship between intramuscular coherence, clinical parameters, and center of mass parameters. In controls, we found that the Target walking task results in increased high-frequency (21–44 Hz) intramuscular coherence, which negatively related to changes in the center of mass movement, whereas this modulation was largely reduced in individuals with iSCI. The impaired modulation of high-frequency intramuscular coherence during the Target walking task correlated with neurophysiological and functional readouts, such as motor-evoked potential amplitude and outdoor mobility score, as well as center of mass trajectory length. The Target walking effect, the difference between Target and Normal walking intramuscular coherence, was significantly higher in controls than in individuals with iSCI [F(1.0,35.0) = 13.042, p < 0.001]. Intramuscular coherence obtained during challenging walking in individuals with iSCI may provide information on corticospinal gait control. The relationships between biomechanics, clinical scores, and neurophysiology suggest that intramuscular coherence assessed during challenging tasks may be meaningful for understanding impaired supra-spinal control in individuals with iSCI.
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Affiliation(s)
- Freschta Zipser-Mohammadzada
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- *Correspondence: Freschta Zipser-Mohammadzada,
| | - Bernard A. Conway
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - David M. Halliday
- Department of Electronic Engineering, University of York, York, United Kingdom
- York Biomedical Research Institute, University of York, York, United Kingdom
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Chris A. Easthope
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- Cereneo Foundation, Center for Interdisciplinary Research, Vitznau, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Department of Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
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6
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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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7
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Fang CY, Lien ASY, Tsai JL, Yang HC, Chan HL, Chen RS, Chang YJ. The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis. Front Physiol 2021; 12:756200. [PMID: 34867459 PMCID: PMC8640241 DOI: 10.3389/fphys.2021.756200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI). Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity. Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = - 1.538 to - 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = - 1.749 to - 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = - 0.0025, SE = 0.0129, p = 0.849, R 2 analog = 0.37). Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.
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Affiliation(s)
- Chia-Ying Fang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Angela Shin-Yu Lien
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jia-Ling Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Chu Yang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Lung Chan
- Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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8
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Towards a Mobile Gait Analysis for Patients with a Spinal Cord Injury: A Robust Algorithm Validated for Slow Walking Speeds. SENSORS 2021; 21:s21217381. [PMID: 34770686 PMCID: PMC8587087 DOI: 10.3390/s21217381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.
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9
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Almutairi SM, Swank C, Wang-Price SS, Gao F, Medley A. Walking with and without a robotic exoskeleton in people with incomplete spinal cord injury compared to a typical gait pattern. NeuroRehabilitation 2021; 49:585-596. [PMID: 34542041 DOI: 10.3233/nre-210187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic exoskeleton (RE) enables individuals with lower extremity weakness or paralysis to stand and walk in a stereotypical pattern. OBJECTIVE Examine whether people with chronic incomplete spinal cord injury (SCI) demonstrate a more typical gait pattern when walking overground in a RE than when walking without. METHODS Motion analysis system synchronized with a surface electromyographic (EMG) was used to obtain temporospatial gait parameters, lower extremity kinematics, and muscle activity in ambulatory individuals with SCI and healthy adults. RESULTS Temporospatial parameters and kinematics for participants with SCI (n = 12; age 41.4±12.5 years) with and without RE were significantly different than a typical gait (healthy adults: n = 15; age 26.2±8.3 years). EMG amplitudes during the stance phase of a typical gait were similar to those with SCI with and without RE, except the right rectus femoris (p = 0.005) and left gluteus medius (p = 0.014) when participants with SCI walked with RE. EMG amplitudes of participants with SCI during the swing phase were significantly greater compared to those of a typical gait, except for left medial hamstring with (p = 0.025) and without (p = 0.196) RE. CONCLUSIONS First-time walking in a RE does not appear to produce a typical gait pattern in people with incomplete SCI.
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Affiliation(s)
- Sattam M Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, USA
| | | | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, USA
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, USA
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10
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Hwang M, Flanagan A, Graf A, Kruger KM, Scullion N, Tayne S, Altiok H. Gait Characteristics in Youth With Transverse Myelitis. Top Spinal Cord Inj Rehabil 2021; 27:38-48. [PMID: 34456545 DOI: 10.46292/sci20-00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Transverse myelitis (TM) in childhood is a rare disorder characterized by the presence of spinal cord inflammation. Gait difficulty in children with TM is common; however, there is a paucity of literature regarding quantitative assessment of gait in children and adolescents with TM. Objectives To characterize gait patterns in a cohort of ambulatory children with TM and age-matched, typically developing peers in order to better understand the functional mobility of patients diagnosed with childhood TM. Methods This was a retrospective study of 26 ambulatory pediatric patients with a confirmed diagnosis of TM who had undergone three-dimensional, instrumented gait analysis (3D-IGA) at 3 years of age or older. A group of 38 typically developing children served as a control group. Results Gait in children with TM was characterized by moderate kinematic deviations as measured by the Gait Deviation Index (GDI) and a crouched gait pattern (p < .001), increased anterior pelvic tilt (p < .001), decreased motion at the knees (p < .001), and a wider base of support (foot progression angle, p < .001). The TM group had a slower walking speed (p < .001), shorter strides (p < .001), and an increased stance phase compared to controls. Conclusion Our study results showed moderate kinematic deviations quantified by the GDI. Overall, the gait pattern in the TM population tested had greater hip and knee flexion with wider foot progression angle. Identification of gait characteristics in children with TM is the first step in predicting changes in gait pattern as they mature over time, which may ultimately allow for targeted intervention to maintain their ambulatory function.
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Affiliation(s)
- Miriam Hwang
- Shriners Hospitals for Children, Chicago, Illinois
| | - Ann Flanagan
- Shriners Hospitals for Children, Chicago, Illinois
| | - Adam Graf
- Shriners Hospitals for Children, Chicago, Illinois
| | - Karen M Kruger
- Shriners Hospitals for Children, Chicago, Illinois.,Marquette University, Milwaukee, Wisconsin
| | | | | | - Haluk Altiok
- Shriners Hospitals for Children, Chicago, Illinois
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11
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Zarkou A, Field-Fote EC. The influence of physiologic and atmospheric variables on spasticity after spinal cord injury. NeuroRehabilitation 2021; 48:353-363. [PMID: 33814472 DOI: 10.3233/nre-201625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of physiological and atmospheric variables are believed to increase spasticity in persons with spinal cord injury (SCI) based on self-reported measures, however, there is limited objective evidence about the influence of these variables on spasticity. OBJECTIVE We investigated the relationship between physiological/ atmospheric variables and level of spasticity in individuals with SCI. METHODS In 53 participants with motor-incomplete SCI, we assessed the influence of age, time since injury, sex, injury severity, neurological level of injury, ability to walk, antispasmodic medication use, temperature, humidity, and barometric pressure on quadriceps spasticity. Spasticity was assessed using the pendulum test first swing excursion (FSE). To categorize participants based on spasticity severity, we performed cluster analysis. We used multivariate stepwise regression to determine variables associated with spasticity severity level. RESULTS Three spasticity groups were identified based on spasticity severity level: low, moderate, and high. The regression analysis revealed that only walking ability and temperature were significantly related to spasticity severity. CONCLUSIONS These outcomes validate the self-reported perception of people with SCI that low temperatures worsen spasticity. The findings refine prior evidence that people with motor-incomplete SCI have higher levels of spasticity, showing that those with sufficient motor function to walk have the highest levels of spasticity.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Edelle C Field-Fote
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA.,Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA, USA.,Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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12
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Gong C, Zheng X, Guo F, Wang Y, Zhang S, Chen J, Sun X, Shah SZA, Zheng Y, Li X, Yin Y, Li Q, Huang X, Guo T, Han X, Zhang SC, Wang W, Chen H. Human spinal GABA neurons alleviate spasticity and improve locomotion in rats with spinal cord injury. Cell Rep 2021; 34:108889. [PMID: 33761348 DOI: 10.1016/j.celrep.2021.108889] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 01/10/2023] Open
Abstract
Spinal cord injury (SCI) often results in spasticity. There is currently no effective therapy for spasticity. Here, we describe a method to efficiently differentiate human pluripotent stem cells from spinal GABA neurons. After transplantation into the injured rat spinal cord, the DREADD (designer receptors exclusively activated by designer drug)-expressing spinal progenitors differentiate into GABA neurons, mitigating spasticity-like response of the rat hindlimbs and locomotion deficits in 3 months. Administering clozapine-N-oxide, which activates the grafted GABA neurons, further alleviates spasticity-like response, suggesting an integration of grafted GABA neurons into the local neural circuit. These results highlight the therapeutic potential of the spinal GABA neurons for SCI.
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Affiliation(s)
- ChenZi Gong
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaolong Zheng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - FangLiang Guo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - YaNan Wang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Song Zhang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - XueJiao Sun
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sayed Zulfiqar Ali Shah
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - YiFeng Zheng
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao Li
- School of Mechanical Engineering, Hubei University of Technology, Wuhan 430068, China
| | - Yatao Yin
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qian Li
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - XiaoLin Huang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tiecheng Guo
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaohua Han
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Su-Chun Zhang
- Waisman Center, Department of Neuroscience and Department of Neurology, University of Wisconsin, Madison, WI, USA; Program in Neuroscience & Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Hong Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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13
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Estes S, Zarkou A, Hope JM, Suri C, Field-Fote EC. Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy. J Clin Med 2021; 10:1167. [PMID: 33799508 PMCID: PMC7999894 DOI: 10.3390/jcm10061167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 01/01/2023] Open
Abstract
Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2-6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury-spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.
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Affiliation(s)
- Stephen Estes
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Anastasia Zarkou
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Jasmine M. Hope
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA 30309, USA; (S.E.); (A.Z.); (J.M.H.); (C.S.)
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
- Program in Biomedical Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA
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14
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Machine learning classifies predictive kinematic features in a mouse model of neurodegeneration. Sci Rep 2021; 11:3950. [PMID: 33597593 PMCID: PMC7889656 DOI: 10.1038/s41598-021-82694-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
Motor deficits are observed in Alzheimer's disease (AD) prior to the appearance of cognitive symptoms. To investigate the role of amyloid proteins in gait disturbances, we characterized locomotion in APP-overexpressing transgenic J20 mice. We used three-dimensional motion capture to characterize quadrupedal locomotion on a treadmill in J20 and wild-type mice. Sixteen J20 mice and fifteen wild-type mice were studied at two ages (4- and 13-month). A random forest (RF) classification algorithm discriminated between the genotypes within each age group using a leave-one-out cross-validation. The balanced accuracy of the RF classification was 92.3 ± 5.2% and 93.3 ± 4.5% as well as False Negative Rate (FNR) of 0.0 ± 0.0% and 0.0 ± 0.0% for the 4-month and 13-month groups, respectively. Feature ranking algorithms identified kinematic features that when considered simultaneously, achieved high genotype classification accuracy. The identified features demonstrated an age-specific kinematic profile of the impact of APP-overexpression. Trunk tilt and unstable hip movement patterns were important in classifying the 4-month J20 mice, whereas patterns of shoulder and iliac crest movement were critical for classifying 13-month J20 mice. Examining multiple kinematic features of gait simultaneously could also be developed to classify motor disorders in humans.
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15
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Yoshizaki S, Yokota K, Kubota K, Saito T, Tanaka M, Konno DJ, Maeda T, Matsumoto Y, Nakashima Y, Okada S. The beneficial aspects of spasticity in relation to ambulatory ability in mice with spinal cord injury. Spinal Cord 2019; 58:537-543. [PMID: 31822806 DOI: 10.1038/s41393-019-0395-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Experimental study with mice. OBJECTIVES Spasticity is a common complication after spinal cord injury (SCI) and has detrimental aspects, such as persistent pain and involuntary muscle spasms. This study aimed to assess the influence of antispastic therapy on locomotor function after SCI. SETTING University-based laboratory in Fukuoka, Japan. METHODS A mouse model of spasticity was developed by producing incomplete SCI at the 9th thoracic level. At 8 weeks after SCI, an antispastic drug, baclofen, was intraperitoneally administered to six injured and two sham-operated mice. The severity of spasticity was evaluated by the modified Ashworth scoring (MAS) system, and locomotor function was evaluated by the Basso-Beattie-Bresnahan (BBB) scale/Basso mouse score (BMS). RESULTS The administration of baclofen significantly improved spasticity in the SCI mice and the mean MAS decreased to from 6.2 to 2.8. However, at the same time, it significantly exacerbated the locomotor dysfunction of the SCI mice and the mean BMS decreased from 4.7 to 2.3. The time-course of the changes in locomotor function coincided with the time-course of the spasticity score. We also confirmed that the administration of baclofen was not associated with any changes in either locomotor function or spasticity of the sham-operated control mice. CONCLUSIONS Our results suggest that spasticity has a certain beneficial effect on ambulation ability. It is important to note that antispastic treatments may be associated with a risk of impairing the preserved function of chronic SCI patients.
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Affiliation(s)
- Shingo Yoshizaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Immunology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, Fukuoka, Japan
| | - Takeyuki Saito
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatake Tanaka
- Department of Immunology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Dai-Jiro Konno
- Department of Immunology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiji Okada
- Department of Immunology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan.
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16
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Visual kinematic feedback enhances the execution of a novel knee flexion gait pattern in children and adolescents. Gait Posture 2019; 74:94-101. [PMID: 31494385 DOI: 10.1016/j.gaitpost.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 04/22/2019] [Accepted: 06/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered knee motion is one of the most common gait deviations in pediatric populations with gait disorders. The potential for pediatric gait retraining using visual feedback based on knee kinematic patterns is under-explored. RESEARCH QUESTION This study investigated whether pediatric participants could successfully modify knee flexion patterns in response to a visual kinematic feedback system (VKFS). METHODS Knee flexion angles from twelve typically developing children and adolescents (6 M, 6 F; 11.9 ± 2.7 years) were calculated using wearable inertial measurement units. Participants were tested while walking on a treadmill using pattern based visual feedback (FB). Four novel target patterns which amplified or attenuated swing phase peak knee flexion were tested. No feedback (NFB) tests assessed the participant's ability to independently reproduce the patterns. Mean absolute cycle error (MACE) and magnitude of peak knee flexion error (PK) were calculated during the last 10 strides of FB and NFB trials. Pre-exposure reference values (R) were also calculated. RESULTS AND SIGNIFICANCE PK-FB was significantly smaller (p < 0.05) than PK-R for all targets. Average values for PK-NFB were higher than for PK-FB, although PK-NFB remained significantly lower than PK-R for two targets. Contrary to one of the study's hypotheses, MACE-FB and MACE-NFB were larger than MACE-R. The study provided evidence that pediatric participants were able to modify peak knee flexion during gait in the sense targeted by the VKFS. Analysis suggested that MACE increases were explained by increases in gait cycle deviation outside of the changed region.
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17
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Murphy AT, Kravtsov S, Sangeux M, Rawicki B, New PW. Utilizing three dimensional clinical gait analysis to optimize mobility outcomes in incomplete spinal cord damage. Gait Posture 2019; 74:53-59. [PMID: 31446333 DOI: 10.1016/j.gaitpost.2019.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 06/25/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.
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Affiliation(s)
- Anna T Murphy
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Stella Kravtsov
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia.
| | - Morgan Sangeux
- Biomech-Intel, Marseille, France; The Murdoch Children's Institute, Parkville, VIC, 3052, Australia; The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Barry Rawicki
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Peter W New
- Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia; Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, VIC, 3162, Australia; Rehabilitation and Aged Services Program, Department of Medicine, Monash Health, Cheltenham, VIC, 3192, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, VIC, 3800, Australia.
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18
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Shin S, Park J, Hong J, Park JH. Improved gait speed in spastic paraplegia: a new modality. BMJ Support Palliat Care 2019; 10:e41. [PMID: 31201153 DOI: 10.1136/bmjspcare-2018-001738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The gait disturbance in spastic paraplegic patients lowers the gait speed, increases fall risk and eventually lower the quality of life. This study aims to investigate the effect of electrical twitch obtaining intramuscular stimulation (ETOIMS) on spastic paraplegic patients' gait speed and pattern. METHODS A prospective short-term cohort study was designed in the outpatient clinic of the department of rehabilitation in a tertiary hospital. Patients with spastic paraplegia (N=5) were participated, including spinal cord tumour (N=2), cervical myelitis (N=1), hereditary spastic paraplegia (NIPA1 mutation; N=1) and spinal cord injury (N=1). The participants underwent ETOIMS. The target muscles were the bilateral quadratus lumborum, multifidus inserting to the L4 and L5 spinous process, and gluteus medius. Gait speed, gait pattern and subjective symptoms, including pain scores (measured by visual analogue scale), were compared before and immediately after the intervention. RESULTS All patients subjectively reported reduced stiffness during walking and alleviated muscular pain in the lower back and gluteal area. After one session of ETOIMS, patient 1-4 showed 57%, 29%, 33% and 6 % improvement in gait speed, respectively, and all patients showed increased pelvic dissociation. CONCLUSIONS The ETOIMS can be effective in improving gait speed and stability by relaxing the muscles or alleviating the pain in the lower back and gluteal area in spastic paraplegic patients.
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Affiliation(s)
- Sanghoon Shin
- Department of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juntaek Hong
- Department of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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19
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Mekhael W, Begum S, Samaddar S, Hassan M, Toruno P, Ahmed M, Gorin A, Maisano M, Ayad M, Ahmed Z. Repeated anodal trans-spinal direct current stimulation results in long-term reduction of spasticity in mice with spinal cord injury. J Physiol 2019; 597:2201-2223. [PMID: 30689208 PMCID: PMC6462463 DOI: 10.1113/jp276952] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/18/2019] [Indexed: 12/30/2022] Open
Abstract
KEY POINTS Spasticity is a disorder of muscle tone that is associated with lesions of the motor system. This condition involves an overactive spinal reflex loop that resists the passive lengthening of muscles. Previously, we established that application of anodal trans-spinal direct current stimulation (a-tsDCS) for short periods of time to anaesthetized mice sustaining a spinal cord injury leads to an instantaneous reduction of spasticity. However, the long-term effects of repeated a-tsDCS and its mechanism of action remained unknown. In the present study, a-tsDCS was performed for 7 days and this was found to cause long-term reduction in spasticity, increased rate-dependent depression in spinal reflexes, and improved ground and skill locomotion. Pharmacological, molecular and cellular evidence further suggest that a novel mechanism involving Na-K-Cl cotransporter isoform 1 mediates the observed long-term effects of repeated a-tsDCS. ABSTRACT Spasticity can cause pain, fatigue and sleep disturbances; restrict daily activities such as walking, sitting and bathing; and complicate rehabilitation efforts. Thus, spasticity negatively influences an individual's quality of life and novel therapeutic interventions are needed. We previously demonstrated in anaesthetized mice that a short period of trans-spinal subthreshold direct current stimulation (tsDCS) reduces spasticity. In the present study, the long-term effects of repeated tsDCS to attenuate abnormal muscle tone in awake female mice with spinal cord injuries were investigated. A motorized system was used to test velocity-dependent ankle resistance and associated electromyographical activity. Analysis of ground and skill locomotion was also performed, with electrophysiological, molecular and cellular studies being conducted to reveal a potential underlying mechanism of action. A 4 week reduction in spasticity was associated with an increase in rate-dependent depression of spinal reflexes, and ground and skill locomotion were improved following 7 days of anodal-tsDCS (a-tsDCS). Secondary molecular, cellular and pharmacological experiments further demonstrated that the expression of K-Cl co-transporter isoform 2 (KCC2) was not changed in animals with spasticity. However, Na-K-Cl cotransporter isoform 1 (NKCC1) was significantly up-regulated in mice that exhibited spasticity. When mice were treated with a-tsDCS, down regulation of NKCC1 was detected, and this level did not significantly differ from that in the non-injured control mice. Thus, long lasting reduction of spasticity by a-tsDCS via downregulation of NKCC1 may constitute a novel therapy for spasticity following spinal cord injury.
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Affiliation(s)
- Wagdy Mekhael
- Graduate CenterCity University of New YorkNew YorkNYUSA
| | - Sultana Begum
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Sreyashi Samaddar
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
- Department of Physical TherapyThe College of Staten IslandStaten IslandNYUSA
| | - Mazen Hassan
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Pedro Toruno
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Malik Ahmed
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Alexis Gorin
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Michael Maisano
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Mark Ayad
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
| | - Zaghloul Ahmed
- Graduate CenterCity University of New YorkNew YorkNYUSA
- Center for Developmental NeuroscienceThe College of Staten IslandStaten IslandNYUSA
- Department of Physical TherapyThe College of Staten IslandStaten IslandNYUSA
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20
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Shekarforoush M, Barton KI, Beveridge JE, Scott M, Martin CR, Muench G, Heard BJ, Sevick JL, Hart DA, Frank CB, Shrive NG. Alterations in Joint Angular Velocity Following Traumatic Knee Injury in Ovine Models. Ann Biomed Eng 2019; 47:790-801. [DOI: 10.1007/s10439-019-02203-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/09/2019] [Indexed: 01/13/2023]
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21
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Phadke CP, Vierira L, Mathur S, Cipriano G, Ismail F, Boulias C. Impact of Passive Leg Cycling in Persons With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2018; 25:83-96. [PMID: 30774292 DOI: 10.1310/sci18-00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Passive leg cycling is an important clinical tool available for rehabilitation after spinal cord injury (SCI). Passive cycling can be used to derive exercise-related benefits in patients with poor motor control. There have been a number of studies examining the effects of passive cycling on a variety of outcomes. There is need for a systematic assessment of the cycling parameters and the associated clinical changes in cardiovascular, neuromuscular, and musculoskeletal outcomes after passive cycling. Objectives: To assess the effectiveness of passive leg cycling interventions on cardiovascular, neuromuscular, and musculoskeletal outcomes post SCI, and to describe intensity, duration, and type of passive leg cycling post SCI. Methods: PRISMA guided systematic review of literature based on searches in the following databases: PubMed/MEDLINE, PEDro, EMBASE, Cochrane Library, and Google Scholar. Peer-reviewed publications that were written in English were included if they described the effects of a single session or multiple sessions of passive leg cycling in persons post SCI. Results: Eleven papers were included: two were randomized controlled trials (RCTs), one was a crossover trial, and the rest were pre-post single-group designs. Three studies (including two RCTs) reported statistically significant benefits of multiple sessions of passive cycling on leg blood flow velocity, spasticity, reflex excitability and joint range of motion, and markers of muscle hypertrophy. About half of the single session studies showed statistically significant improvement in acute responses. Conclusion: Multiple sessions of passive leg cycling showed benefits in three categories - cardiovascular, musculoskeletal, and neurological - with medium to large effect sizes.
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Affiliation(s)
- Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Vierira
- Health Sciences and Technologies PhD Program, University of Brasilia, Brasilia, Brazil
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gerson Cipriano
- Division of Physical Therapy - Ceilandia College, University of Brasilia, Brasilia, Brazil
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
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22
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In T, Jung K, Lee MG, Cho HY. Whole-body vibration improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury. NeuroRehabilitation 2018; 42:491-497. [PMID: 29660953 DOI: 10.3233/nre-172333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to investigate the effects of whole-body vibration (WBV) training on ankle spasticity, balance, and walking ability in patients with incomplete spinal cord injury (iSCI) at cervical level. METHODS Twenty-eight patients with cervical iSCI were randomly assigned to WBV (n = 14) or control group (n = 14). WBV group received WBV training, while control group was treated with placebo-treatment. All interventions were given for 20-min, twice a day, 5-days a week for 8-weeks. The spasticity of ankle plantar-flexors was assessed by estimating passive resistive force using a hand-held dynamometer. Balance was analyzed based on postural sway length (PSL) using a force plate. Timed-Up and Go test (TUG) and 10 m-Walk Test (10MWT) were used to assess walking ability. RESULTS Both groups showed significant improvements in spasticity, balance and walking ability. Also, the significant differences between two groups were demonstrated in the outcomes of spasticity (3.0±1.7 vs 0.9±1.2), PSL (6.4±1.2 vs 3.2±0.9 with eyes-open, and 15.1±10.9 vs 7.4±4.3 with eyes-closed), TUG (2.3±1.3 vs 1.0±1.0), and 10MWT (3.5±2.3 vs 1.3±1.4). CONCLUSIONS WBV may be a safe and effective intervention to improve spasticity, balance and walking ability in individuals with cervical iSCI. Thus, WBV may be used to improve these symptoms in clinics.
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Affiliation(s)
- Taesung In
- Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea
| | - Kyoungsim Jung
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
| | - Min-Goo Lee
- Department of Physiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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23
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Hinahon E, Estrada C, Tong L, Won DS, de Leon RD. Robot-Applied Resistance Augments the Effects of Body Weight-Supported Treadmill Training on Stepping and Synaptic Plasticity in a Rodent Model of Spinal Cord Injury. Neurorehabil Neural Repair 2017; 31:746-757. [PMID: 28741434 DOI: 10.1177/1545968317721016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The application of resistive forces has been used during body weight-supported treadmill training (BWSTT) to improve walking function after spinal cord injury (SCI). Whether this form of training actually augments the effects of BWSTT is not yet known. OBJECTIVE To determine if robotic-applied resistance augments the effects of BWSTT using a controlled experimental design in a rodent model of SCI. METHODS Spinally contused rats were treadmill trained using robotic resistance against horizontal (n = 9) or vertical (n = 8) hind limb movements. Hind limb stepping was tested before and after 6 weeks of training. Two control groups, one receiving standard training (ie, without resistance; n = 9) and one untrained (n = 8), were also tested. At the terminal experiment, the spinal cords were prepared for immunohistochemical analysis of synaptophysin. RESULTS Six weeks of training with horizontal resistance increased step length, whereas training with vertical resistance enhanced step height and movement velocity. None of these changes occurred in the group that received standard (ie, no resistance) training or in the untrained group. Only standard training increased the number of step cycles and shortened cycle period toward normal values. Synaptophysin expression in the ventral horn was highest in rats trained with horizontal resistance and in untrained rats and was positively correlated with step length. CONCLUSIONS Adding robotic-applied resistance to BWSTT produced gains in locomotor function over BWSTT alone. The impact of resistive forces on spinal connections may depend on the nature of the resistive forces and the synaptic milieu that is present after SCI.
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Affiliation(s)
| | | | - Lin Tong
- 1 California State University Los Angeles, CA, USA
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An Explicit Method for Analysis of Three-Dimensional Linear and Angular Velocity of a Joint, with Specific Application to the Knee Joint. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0298-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vargas Luna JL, Guðfinnsdóttir HK, Magnúsdóttir G, Guðmundsdóttir V, Krenn M, Mayr W, Ludvigsdóttir GK, Helgason T. Effects of sustained electrical stimulation on spasticity assessed by the pendulum test. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2016. [DOI: 10.1515/cdbme-2016-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractNeuromodulation using electrical stimulation is able to enhance motor control of individuals suffering an upper motor neuron disorder. This work examined the effect of sustained electrical stimulation to modify spasticity in the leg muscles. We applied transcutaneous spinal cord stimulation with a pulse rate of 50 Hz for 30 min. The subjects were assessed before and after the intervention using in a pendulum test setup. The motion of the free swinging leg was acquired through video tracking and goniometer measurements. The quantification was done through the R2n index which shows consistency identifying the spasticity levels. In all incomplete SCI subjects having severe spasticity, the results show that electrical stimulation is effective to modify the increased muscle tone.
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Affiliation(s)
- José L. Vargas Luna
- 1Reykjavik University/Landspítali University Hospital, Menntavegur 1, 101 Reykjavík, Iceland
- 2Tecnologico de Monterrey, E. Garza Sada 2501, 64849 Monterrey, Mexico
| | | | - Gígja Magnúsdóttir
- 4Landspítali University Hospital, Grensás við Álmgerði, 108 Reykjavík, Iceland
| | | | - Matthias Krenn
- 5Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- 6Vienna University of Technology, Gusshausstrasse 27, 1040 Vienna, Austria
| | - Winfried Mayr
- 5Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | | | - Thordur Helgason
- 1Reykjavik University/Landspítali University Hospital, Menntavegur 1, 101 Reykjavík, Iceland
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Awai L, Curt A. Locomotor Recovery in Spinal Cord Injury: Insights Beyond Walking Speed and Distance. J Neurotrauma 2016; 33:1428-35. [DOI: 10.1089/neu.2015.4154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Kim Y, Kim SH, Kim KH, Chae S, Kim C, Kim J, Shin HS, Lee MS, Kim D. Age-dependent gait abnormalities in mice lacking the Rnf170 gene linked to human autosomal-dominant sensory ataxia. Hum Mol Genet 2015; 24:7196-206. [PMID: 26433933 DOI: 10.1093/hmg/ddv417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/29/2015] [Indexed: 01/05/2023] Open
Abstract
Really interesting new gene (RING) finger protein 170 (RNF170) is an E3 ubiquitin ligase known to mediate ubiquitination-dependent degradation of type-I inositol 1,4,5-trisphosphate receptors (ITPR1). It has recently been demonstrated that a point mutation of RNF170 gene is linked with autosomal-dominant sensory ataxia (ADSA), which is characterized by an age-dependent increase of walking abnormalities, a rare genetic disorder reported in only two families. Although this mutant allele is known to be dominant, the functional identity thereof has not been clearly established. Here, we generated mice lacking Rnf170 (Rnf170(-/-)) to evaluate the effect of its loss of function in vivo. Remarkably, Rnf170(-/-) mice began to develop gait abnormalities in old age (12 months) in the form of asynchronous stepping between diagonal limb pairs with a fixed step sequence during locomotion, while age-matched wild-type mice showed stable gait patterns using several step sequence repertoires. As reported in ADSA patients, they also showed a reduced sensitivity for proprioception and thermal nociception. Protein blot analysis revealed that the amount of Itpr1 protein was significantly elevated in the cerebellum and spinal cord but intact in the cerebral cortex in Rnf170(-/-) mice. These results suggest that the loss of Rnf170 gene function mediates ADSA-associated phenotypes and this gives insights on the cure of patients with ADSA and other age-dependent walking abnormalities.
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Affiliation(s)
- Youngsoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), 335 Gwahak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea, Graduate School of Medical Science and Engineering
| | - Seong Hun Kim
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | | | - Sujin Chae
- KAIST Institute for BioCentury, KAIST, Daejeon 305-701, Republic of Korea
| | - Chanki Kim
- Center for Cognition and Sociality, Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - Jeongjin Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), 335 Gwahak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea
| | - Hee-Sup Shin
- Center for Cognition and Sociality, Institute for Basic Science (IBS), Daejeon, Republic of Korea
| | - Myung-Shik Lee
- Severans Biomedical Research Center Institute, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Republic of Korea and
| | - Daesoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), 335 Gwahak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea,
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de Azevedo ERFBM, Maria RM, Alonso KC, Cliquet A. Posture Influence on the Pendulum Test of Spasticity in Patients with Spinal Cord Injury. Artif Organs 2015; 39:1033-7. [PMID: 25981691 DOI: 10.1111/aor.12500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study aims to investigate the influence of different postures on spasticity results by pendulum test in patients with spinal cord injury (SCI). The setting was at the University of Campinas (UNICAMP), Campinas, SP, Brazil. Five individuals with SCI and five individuals in the control group were included. All individuals went through the pendulum test in three different positions: supine, semi-supine at an angle of 30°, and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times. Blood pressure was monitored during tests. Relaxation index (RI), normalized relaxation index (RIn), test duration in seconds, initial flexion angle, and resting angle were analyzed at three different positions. Results were compared between different positions, and statistically no differences were found. In individuals with SCI, RI (1.83 ± 0.2), RIn (1.14 ± 0.13), and test duration values (13.95 ± 4.14), in sitting up position, were similar to the control group results. In sitting up position, patients showed spasticity reduction. However, the other two postures produce pain and increase blood pressure in patients with tetraplegia. Therefore, these postures should be avoided in patients with lesions above T6, due to possible autonomic dysreflexia symptoms.
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Affiliation(s)
| | - Renata Manzano Maria
- Biomechanics and Rehabilitation Laboratory, Department of Orthopedics and Traumatology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Karina Cristina Alonso
- Biomechanics and Rehabilitation Laboratory, Department of Orthopedics and Traumatology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Alberto Cliquet
- Biomechanics and Rehabilitation Laboratory, Department of Orthopedics and Traumatology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil.,Biocybernetics and Rehabilitation Engineering Laboratory, Department of Electrical Engineering, University of São Paulo-USP, São Carlos, SP, Brazil
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Awai L, Curt A. Comprehensive assessment of walking function after human spinal cord injury. PROGRESS IN BRAIN RESEARCH 2015; 218:1-14. [PMID: 25890130 DOI: 10.1016/bs.pbr.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Regaining any locomotor function after spinal cord injury is not only of immediate importance for affected patients but also for clinical research as it allows to investigate mechanisms underlying motor impairment and locomotor recovery. Clinical scores inform on functional outcomes that are clinically meaningful to value effects of therapy while they all lack the ability to explain underlying mechanisms of recovery. For this purpose, more elaborate recordings of walking kinematics combined with assessments of spinal cord conductivity and muscle activation patterns are required. A comprehensive assessment framework comprising of multiple complementary modalities is necessary. This will not only allow for capturing even subtle changes induced by interventions that are likely missed by standard clinical outcome measures. It will be fundamental to attribute observed changes to naturally occurring spontaneous recovery in contrast to specific changes induced by novel therapeutic interventions beyond the improvements achieved by conventional therapy.
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Affiliation(s)
- Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
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Yaşar E, Yılmaz B, Göktepe S, Kesikburun S. The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury. Spinal Cord 2015; 53:866-9. [PMID: 25687513 DOI: 10.1038/sc.2015.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective single-arm study. OBJECTIVES To investigate the effect of functional electrical stimulation (FES) cycling on late functional recovery, spasticity, gait parameters and oxygen consumption during walking in patients with chronic incomplete spinal cord injury (SCI). SETTING Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS Ten patients with chronic (duration of more than 2 years) incomplete SCI who could ambulate at least 10 m independently or with the assistance of a cane or walker, but no hip-knee-ankle-foot orthosis. The subjects underwent 1-h FES cycling sessions three times a week for 16 weeks. Outcome measures including the total motor score, the Functional Independence Measure (FIM) score, the Modified Ashworth Scale for knee spasticity, temporal spatial gait parameters and oxygen consumption rate during walking were assessed at baseline, 3 and 6 months after the baseline. RESULTS There were statistically significant improvements in total motor scores, the FIM scores and spasticity level at the 6-month follow-up (P<0.01). The changes in gait parameters reached no significant level (P>0.05). Oxygen consumption rate of the patients showed significant reduction at only 6 months compared with baseline (P<0.01). CONCLUSION The results suggest that FES cycling may provide some functional improvements in the late period of SCI. SPONSORSHIP The study was supported by The Scientific and Technological Research Council of Turkey (TUBITAK).
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Affiliation(s)
- E Yaşar
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - B Yılmaz
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Göktepe
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
| | - S Kesikburun
- Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey
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Yen SC, Landry JM, Wu M. Size of kinematic error affects retention of locomotor adaptation in human spinal cord injury. ACTA ACUST UNITED AC 2014; 50:1187-200. [PMID: 24458960 DOI: 10.1682/jrrd.2012.09.0175] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/01/2013] [Indexed: 11/05/2022]
Abstract
Studies in arm motor adaptation suggest that introducing small errors during the adaptation period may lead to a longer retention of the aftereffect than introducing large errors. However, it is unclear whether this notion can be generalized to locomotor adaptation in patients with incomplete spinal cord injury (SCI). We hypothesized that a smaller error size may lead to longer retention of the aftereffect in patients with SCI. We recruited 12 subjects with incomplete SCI for this study. They were instructed to walk on a treadmill while light-, medium-, and heavy-resistance loads were applied to the right ankle to perturb leg swing. Each of the three resistance-load conditions were specific to the subject and determined by each subject's maximum voluntary contraction of the hip flexors. We observed that subjects tended to make larger errors when the resistance-load condition was greater. Following resistance load release, subjects showed an aftereffect consisting of an increase in stride length. Further, the aftereffect was retained longer in the medium-resistance load condition than in the heavy- and light-resistance load conditions. This finding suggests that a patient-specific resistance load may be needed to facilitate retention of locomotor adaptation in patients with incomplete SCI.
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Affiliation(s)
- Sheng-Che Yen
- Department of Physical Therapy, Bouve College of Health Sciences, Northeastern University, Boston, MA
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Leech KA, Kinnaird CR, Hornby TG. Effects of serotonergic medications on locomotor performance in humans with incomplete spinal cord injury. J Neurotrauma 2014; 31:1334-42. [PMID: 24742292 DOI: 10.1089/neu.2013.3206] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Incomplete spinal cord injury (iSCI) often results in significant motor impairments that lead to decreased functional mobility. Loss of descending serotonergic (5HT) input to spinal circuits is thought to contribute to motor impairments, with enhanced motor function demonstrated through augmentation of 5HT signaling. However, the presence of spastic motor behaviors in SCI is attributed, in part, to changes in spinal 5HT receptors that augment their activity in the absence of 5HT, although data demonstrating motor effects of 5HT agents that deactivate these receptors are conflicting. The effects of enhancement or depression of 5HT signaling on locomotor function have not been thoroughly evaluated in human iSCI. Therefore, the aim of the current study was to investigate acute effects of 5HT medications on locomotion in 10 subjects with chronic (>1 year) iSCI. Peak overground and treadmill locomotor performance, including measures of gait kinematics, electromyographic (EMG) activity, and oxygen consumption, were assessed before and after single-dose administration of either a selective serotonin reuptake inhibitor (SSRI) or a 5HT antagonist using a double-blinded, randomized, cross-over design. Results indicate that neither medication led to improvements in locomotion, with a significant decrease in peak overground gait speed observed after 5HT antagonists (from 0.8±0.1 to 0.7±0.1 m/s; p=0.01). Additionally, 5-HT medications had differential effects on EMG activity, with 5HT antagonists decreasing extensor activity and SSRIs increasing flexor activity. Our data therefore suggest that acute manipulation of 5HT signaling, despite changes in muscle activity, does not improve locomotor performance after iSCI.
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Affiliation(s)
- Kristan A Leech
- 1 Northwestern University Interdepartmental Neuroscience Program , Northwestern University, Chicago, Illinois
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Kitade I, Arishima H, Kikuta KI. Effect of the Intrathecal Baclofen Screening Test on the Spatiotemporal Gait Motion Parameters of Patients with Cervical Spinal Cord Injuries Who Exhibited Diffuse Spasticity: A Report of Three Cases. NMC Case Rep J 2014; 1:20-23. [PMID: 28663947 PMCID: PMC5364939 DOI: 10.2176/nmccrj.2013-0301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/06/2013] [Indexed: 11/20/2022] Open
Abstract
We examine the quantitative changes in the gait motion of patients with cervical spinal cord injuries (CSCIs) before and after the intrathecal baclofen (ITB) screening test. The subjects were three patients with CSCI, who exhibited spasticity in the lower extremities. They could all walk 10 or more meters with/without aids. All patients were subjected to the ITB screening test, in which they had gabalon (50 μg) injected into their spinal column via paramedian puncture at the L3–4 level. The subjects had their ankle clonus; patellar tendon reflex; and modified Ashworth scale, Berg balance scale, Spinal Cord Independence Measure, and 10 -meter walk test (10MWT) assessed before and 5 hours after the ITB screening test. At 5 hours after the ITB screening test, all of the patients exhibited decreased spasticity in static position, and improved balance. There were no differences in the abilities of any of the patients to perform ADL. One patient did not change the spatiotemporal gait motion parameters (walking time, step count, and step length in the 10MW T). Therefore, the pomp implantation for ITB therapy was not performed. Two patients who had suffered CSCI more than 20 years ago exhibited a reduced walking time, increased step count, and step length. Out of the two patients one received the pomp of implantation after ITB screening test, and the other was planned to operate. The spatiotemporal gait motion parameters might be one of the useful tests to decide the pomp implantation for CSCI patients who hope improvement of gait ability.
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Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui Hospital, Yoshida-gun, Fukui
| | - Hidetaka Arishima
- Department of Neurosurgery, University of Fukui Hospital, Yoshida-gun, Fukui
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, University of Fukui Hospital, Yoshida-gun, Fukui
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Esclarín-Ruz A, Alcobendas-Maestro M, Casado-Lopez R, Perez-Mateos G, Florido-Sanchez MA, Gonzalez-Valdizan E, Martin JLR. A Comparison of Robotic Walking Therapy and Conventional Walking Therapy in Individuals With Upper Versus Lower Motor Neuron Lesions: A Randomized Controlled Trial. Arch Phys Med Rehabil 2014; 95:1023-31. [DOI: 10.1016/j.apmr.2013.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/18/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Awai L, Curt A. Intralimb coordination as a sensitive indicator of motor-control impairment after spinal cord injury. Front Hum Neurosci 2014; 8:148. [PMID: 24672464 PMCID: PMC3956041 DOI: 10.3389/fnhum.2014.00148] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/27/2014] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich Zurich, Switzerland
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Hofstoetter US, McKay WB, Tansey KE, Mayr W, Kern H, Minassian K. Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury. J Spinal Cord Med 2014; 37:202-11. [PMID: 24090290 PMCID: PMC4066429 DOI: 10.1179/2045772313y.0000000149] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To examine the effects of transcutaneous spinal cord stimulation (tSCS) on lower-limb spasticity. DESIGN Interventional pilot study to produce preliminary data. SETTING Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria. PARTICIPANTS Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m. INTERVENTIONS Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 ms-width pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs. OUTCOME MEASURES The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function. RESULTS The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre- to 0.9 ± 0.3 post-stimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre- to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%. CONCLUSION These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted.
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Affiliation(s)
- Ursula S. Hofstoetter
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria,Correspondence to: Ursula S. Hofstoetter, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20/4L, A-1090 Vienna, Austria.
| | - William B. McKay
- Hulse Spinal Cord Injury Lab, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | | | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Karen Minassian
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Abstract
OBJECTIVE Although no data are available on the effects of water environment on the gait of subjects with spinal cord injury (SCI), hydrotherapy is used in the rehabilitation protocols of SCI patients. The aim of this study was to characterize gait features of subjects with incomplete SCI walking in water and on land in comparison with healthy controls (CTRLs) to identify the specificity of water environment on influencing gait in SCI subjects. DESIGN This is a matched case-control study. RESULTS Kinematic gait parameters and range of motion of joint angles of 15 SCI subjects and 15 CTRLs were analyzed. Compared with gait on land, gait in water of the SCI patients was characterized by speed and stance phase reduction, gait cycle time increment, and invariance of stride length and range of motion values. Comparison with CTRL data remarked that walking in water reduces gait differences between the groups. Furthermore, in water, the SCI subjects presented a reduction in variability of the hip and knee joint angles, whereas in the CTRLs, a larger variability was observed. CONCLUSIONS Gait in water of the SCI subjects is associated with kinematic parameters more similar to those of the CTRLs, particularly regarding speed, stride length, and stance phase, supporting the idea that walking in a water environment may be of rehabilitative significance for SCI subjects.
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Wirth B, van Hedel H, Curt A. Foot control in incomplete SCI: distinction between paresis and dexterity. Neurol Res 2013; 30:52-60. [DOI: 10.1179/174313208x297030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pathophysiology of Gait Disturbance in Neurologic Disorders and Clinical Presentations. Phys Med Rehabil Clin N Am 2013; 24:233-46. [DOI: 10.1016/j.pmr.2012.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Gil-Agudo A, Pérez-Nombela S, Pérez-Rizo E, del Ama-Espinosa A, Crespo-Ruiz B, Pons JL. Comparative biomechanical analysis of gait in patients with central cord and Brown-Séquard syndrome. Disabil Rehabil 2013; 35:1869-76. [DOI: 10.3109/09638288.2013.766268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bani MA, Arazpour M, Ghomshe FT, Mousavi ME, Hutchins SW. Gait evaluation of the advanced reciprocating gait orthosis with solid versus dorsi flexion assist ankle foot orthoses in paraplegic patients. Prosthet Orthot Int 2013; 37:161-7. [PMID: 22988045 DOI: 10.1177/0309364612457704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mechanical orthoses are used for standing and walking after neurological injury. Most orthoses such as the advanced reciprocating gait orthosis typically use solid ankle-foot orthoses. OBJECTIVES The goal of this study was to test the effects of ankle dorsiflexion assistance in patients with spinal cord injury when ambulating with an advanced reciprocating gait orthosis compared to walking with fixed ankles. STUDY DESIGN Quasi-experimental. METHODS Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis equipped with solid and dorsiflexion assist-type ankle-foot orthoses and walked at their self-selected speed. Joint angles and spatial-temporal parameters were measured and analyzed. RESULTS The mean walking speed and stride length were both significantly increased along with cadence by the volunteer subjects when ambulating using the advanced reciprocating gait orthosis fitted with dorsiflexion assist ankle-foot orthoses compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. The mean ankle joint ranges of motion were significantly increased when walking with the advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses compared to when using the advanced reciprocating gait orthosis with the solid ankle-foot orthoses. Knee joint ranges of motion were reduced, and hip joint ranges of motion were increased but not significantly. CONCLUSION The advanced reciprocating gait orthosis fitted with the dorsiflexion assist ankle-foot orthoses had the effect of improving gait parameters when compared to the advanced reciprocating gait orthosis with solid ankle-foot orthoses. Clinical relevance The advanced reciprocating gait orthosis with dorsiflexion assist ankle-foot orthoses has the potential to improve hip and ankle joint kinematics and the temporal-spatial parameters of gait in spinal cord injury patients' walking.
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Affiliation(s)
- Monireh Ahmadi Bani
- Student Research Committee, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Arazpour M, Tajik HR, Aminian G, Bani MA, Ghomshe FT, Hutchins SW. Comparison of the effects of solid versus hinged ankle foot orthoses on select temporal gait parameters in patients with incomplete spinal cord injury during treadmill walking. Prosthet Orthot Int 2013; 37:70-5. [PMID: 22751217 DOI: 10.1177/0309364612448511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle foot orthoses (AFOs) are usually used for patients with incomplete spinal cord injury (ISCI) to provide support in walking. OBJECTIVES The aim of this study was to compare the effect of AFOs, with and without ankle hinges, on specific gait parameters during treadmill training by subjects with ISCI. STUDY DESIGN Quasi-experimental. METHODS Five patients with ISCI at the thoracic level participated in this study. Gait evaluation was performed when walking 1) barefoot 2) wearing a solid AFO and 3) wearing a hinged AFO. RESULTS The mean step length when walking barefoot was 26.3 ± 16.37 cm compared to 31.3 ± 17.27 cm with a solid AFO and 28.5 ± 15.86 cm with a hinged AFO. The mean cadence for walking barefoot was 61.59 ± 25.65 steps/min. compared to 50.94 ± 22.36 steps/min. with a solid AFO and 56.25 ± 24.44 steps/min with a hinged AFO. Significant differences in cadence and step length during walking were only demonstrated between the barefoot condition and when wearing a solid AFO. Significant difference was not observed between conditions in mean of ankle range of motion. CONCLUSION The solid AFO was the only condition which improved cadence and step length in patients during ISCI gait training. Clinical relevance A solid AFO could be used permanently to compensate for impaired ankle function or it could be used while retraining stepping.
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Affiliation(s)
- Mokhtar Arazpour
- University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Abstract
Walking is possible for many patients with a spinal cord injury. Avenues enabling walking include braces, robotics and FES. Among the benefits are improved musculoskeletal and mental health, however unrealistic expectations may lead to negative changes in quality of life. Use rigorous assessment standards to gauge the improvement of walking during the rehabilitation process, but also yearly. Continued walking after discharge may be limited by challenges, such as lack of accessibility in and outside the home, and complications, such as shoulder pain or injuries from falls. It is critical to determine the risks and benefits of walking for each patient.
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Affiliation(s)
- Elizabeth C Hardin
- Motion Study Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.
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Choi BR, Kim JH, Lee JU, Kim J. The Effects of Hippotherapy on Standing Balance in Patients with Incomplete Cervical Spinal Cord Injuries: A Pilot Study. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/nm.2013.41002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:47-62. [PMID: 23098705 DOI: 10.1016/b978-0-444-52137-8.00003-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Spinal cord injury (SCI) is a sudden, life-altering event. Injury severity and accompanying recovery vary considerably from individual to individual. The most important determinant of prognosis is whether an injury is clinically complete or incomplete. While approximately 10-20% of complete injuries convert to incomplete during the first year post-injury, the magnitude of motor recovery following complete SCI is limited or absent. Robust functional motor recovery (e.g., weight-bearing, ambulation) distal to the zone of injury is rare. Recovery following incomplete SCI is particularly variable, and anywhere from 20% to 75% of individuals will recover some degree of walking capacity by 1 year post-injury. This is related to presenting injury severity (American Spinal Injury Association Impairment Scale grade); however, even 20-50% of individuals who present as motor complete, sensory incomplete will walk in some capacity by 1 year post-injury. Regardless, for both complete and incomplete injuries, the majority of recovery is observed during the initial 9-12 months, with a relative plateau reached by 12-18 months post-injury. Magnetic resonance imaging (MRI) provides valuable adjunct information when a bedside clinical assessment cannot be completed. The presence of intramedullary hemorrhage and extended segments of edema have been associated with clinically complete SCI.
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Locomotor adaptation to resistance during treadmill training transfers to overground walking in human SCI. Exp Brain Res 2011; 216:473-82. [PMID: 22108702 DOI: 10.1007/s00221-011-2950-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 11/09/2011] [Indexed: 10/15/2022]
Abstract
Treadmill training has been used as a promising technique to improve overground walking in patients with spinal cord injury (SCI). Previous findings showed that a gait pattern may adapt to a force perturbation during treadmill training and show aftereffects following removal of the force perturbation. We hypothesized that aftereffects would transfer to overground walking to a greater extent when the force perturbation was resisting rather than assisting leg swing during treadmill training. Ten subjects with incomplete SCI were recruited into this study for two treadmill training sessions: one using swing resistance and the other using swing assistance during treadmill stepping. A controlled resistance/assistance was provided to the subjects' right knee using a customized cable-driven robot. The subjects' spatial and temporal parameters were recorded during the training. The same parameters during overground walking were also recorded before and after the training session using an instrumented walkway. Results indicated that stride length during treadmill stepping increased following the release of resistance load and the aftereffect transferred to overground walking. In contrast, stride length during treadmill stepping decreased following the release of assistance load, but the aftereffect did not transfer to overground walking. Providing swing resistance during treadmill training could enhance the active involvement of the subjects in the gait motor task, thereby aiding in the transfer to overground walking. Such a paradigm may be useful as an adjunct approach to improve the locomotor function in patients with incomplete SCI.
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Nadeau S, Duclos C, Bouyer L, Richards CL. Guiding task-oriented gait training after stroke or spinal cord injury by means of a biomechanical gait analysis. PROGRESS IN BRAIN RESEARCH 2011; 192:161-80. [PMID: 21763525 DOI: 10.1016/b978-0-444-53355-5.00011-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To recover the ability to walk is one of the most important goals of persons recovering from a stroke or spinal cord injury (SCI). While a task-oriented approach to gait training is recommended, randomized controlled trials or meta-analyses comparing different methods of delivering training have failed in general to demonstrate the superiority of one approach over the other. The large variations in the mean outcome gait measures reported in these studies reflect, at least in part, the heterogeneity of the sensorimotor impairments underlying the gait disability as well as variations in the therapeutic response. The purpose of this chapter is to demonstrate that biomechanical gait analysis can reveal information pertinent to the selection of a task-oriented approach to enhance gait training as well as the therapeutic response that clinical evaluations alone cannot provide. We first briefly review locomotor impairments underlying the gait disability after stroke and SCI as well as the effects of selected technological task-oriented gait training interventions. We then give examples that demonstrate the use of gait analysis to pinpoint underlying impairments that can guide the choice of sensorimotor therapy and then immediately identify responders to the intervention. Such an individualized approach should promote therapeutic efficacy while leading over time to the identification of clinical indices to guide therapy when gait analysis is not feasible. Given the requirements of a gait analysis laboratory and the qualified personnel to capture and interpret the data, future studies will need to demonstrate the feasibility of the technological proposed approach and assess the costs and benefits for the health care system.
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Affiliation(s)
- Sylvie Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
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Quantification and recognition of parkinsonian gait from monocular video imaging using kernel-based principal component analysis. Biomed Eng Online 2011; 10:99. [PMID: 22074315 PMCID: PMC3354347 DOI: 10.1186/1475-925x-10-99] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The computer-aided identification of specific gait patterns is an important issue in the assessment of Parkinson's disease (PD). In this study, a computer vision-based gait analysis approach is developed to assist the clinical assessments of PD with kernel-based principal component analysis (KPCA). METHOD Twelve PD patients and twelve healthy adults with no neurological history or motor disorders within the past six months were recruited and separated according to their "Non-PD", "Drug-On", and "Drug-Off" states. The participants were asked to wear light-colored clothing and perform three walking trials through a corridor decorated with a navy curtain at their natural pace. The participants' gait performance during the steady-state walking period was captured by a digital camera for gait analysis. The collected walking image frames were then transformed into binary silhouettes for noise reduction and compression. Using the developed KPCA-based method, the features within the binary silhouettes can be extracted to quantitatively determine the gait cycle time, stride length, walking velocity, and cadence. RESULTS AND DISCUSSION The KPCA-based method uses a feature-extraction approach, which was verified to be more effective than traditional image area and principal component analysis (PCA) approaches in classifying "Non-PD" controls and "Drug-Off/On" PD patients. Encouragingly, this method has a high accuracy rate, 80.51%, for recognizing different gaits. Quantitative gait parameters are obtained, and the power spectrums of the patients' gaits are analyzed. We show that that the slow and irregular actions of PD patients during walking tend to transfer some of the power from the main lobe frequency to a lower frequency band. Our results indicate the feasibility of using gait performance to evaluate the motor function of patients with PD. CONCLUSION This KPCA-based method requires only a digital camera and a decorated corridor setup. The ease of use and installation of the current method provides clinicians and researchers a low cost solution to monitor the progression of and the treatment to PD. In summary, the proposed method provides an alternative to perform gait analysis for patients with PD.
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Kohout RK, Saunders LL, Krause JS. The relationship between prescription medication use and ability to ambulate distances after spinal cord injury. Arch Phys Med Rehabil 2011; 92:1246-9. [PMID: 21807143 DOI: 10.1016/j.apmr.2011.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/02/2011] [Accepted: 03/02/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the relationship between prescription medication use for pain and spasticity and ambulation distances while controlling for pain severity, injury severity, age, sex, and race in participants with spinal cord injury (SCI). DESIGN Secondary analysis of survey data. SETTING Specialty hospital in the Southeast United States. PARTICIPANTS Adults (N=407) with traumatic SCI identified through inpatient and outpatient hospital databases. INTERVENTION Not applicable. MAIN OUTCOMES MEASURES A questionnaire measured prescription medication use, ambulation distance, and other demographic data. A composite score of four 10-point scales from the Brief Pain Inventory was used to measure pain severity. Multinomial logistic regression was used to calculate the odds ratio (OR) of ambulation distance using 1000 ft or more as the reference group. RESULTS Persons with SCI who were heavy prescription medication users (defined as weekly or daily use for pain or spasticity) were more likely to be limited to distances less than 150 (OR, 2.82; 95% confidence interval [CI], 1.57-5.04) and 150 to 999 ft (OR, 2.52; 95% CI, 1.45-4.39). CONCLUSION Heavy prescription medication use for pain and spasticity was related inversely to a person's ability to achieve community ambulation distances of 1000 ft or more.
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Affiliation(s)
- Ryan K Kohout
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425, USA
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Do AH, Wang PT, King CE, Abiri A, Nenadic Z. Brain-computer interface controlled functional electrical stimulation system for ankle movement. J Neuroeng Rehabil 2011; 8:49. [PMID: 21867567 PMCID: PMC3247850 DOI: 10.1186/1743-0003-8-49] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 08/26/2011] [Indexed: 11/22/2022] Open
Abstract
Background Many neurological conditions, such as stroke, spinal cord injury, and traumatic brain injury, can cause chronic gait function impairment due to foot-drop. Current physiotherapy techniques provide only a limited degree of motor function recovery in these individuals, and therefore novel therapies are needed. Brain-computer interface (BCI) is a relatively novel technology with a potential to restore, substitute, or augment lost motor behaviors in patients with neurological injuries. Here, we describe the first successful integration of a noninvasive electroencephalogram (EEG)-based BCI with a noninvasive functional electrical stimulation (FES) system that enables the direct brain control of foot dorsiflexion in able-bodied individuals. Methods A noninvasive EEG-based BCI system was integrated with a noninvasive FES system for foot dorsiflexion. Subjects underwent computer-cued epochs of repetitive foot dorsiflexion and idling while their EEG signals were recorded and stored for offline analysis. The analysis generated a prediction model that allowed EEG data to be analyzed and classified in real time during online BCI operation. The real-time online performance of the integrated BCI-FES system was tested in a group of five able-bodied subjects who used repetitive foot dorsiflexion to elicit BCI-FES mediated dorsiflexion of the contralateral foot. Results Five able-bodied subjects performed 10 alternations of idling and repetitive foot dorsifiexion to trigger BCI-FES mediated dorsifiexion of the contralateral foot. The epochs of BCI-FES mediated foot dorsifiexion were highly correlated with the epochs of voluntary foot dorsifiexion (correlation coefficient ranged between 0.59 and 0.77) with latencies ranging from 1.4 sec to 3.1 sec. In addition, all subjects achieved a 100% BCI-FES response (no omissions), and one subject had a single false alarm. Conclusions This study suggests that the integration of a noninvasive BCI with a lower-extremity FES system is feasible. With additional modifications, the proposed BCI-FES system may offer a novel and effective therapy in the neuro-rehabilitation of individuals with lower extremity paralysis due to neurological injuries.
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Affiliation(s)
- An H Do
- Department of Neurology, University of California, Irvine, CA 92697, USA.
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