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Cathomen A, Meier F, Lerch I, Killeen T, Zörner B, Curt A, Bolliger M. Corticospinal control of a challenging ankle task in incomplete spinal cord injury. J Neurotrauma 2022; 40:952-964. [PMID: 36029211 DOI: 10.1089/neu.2022.0205] [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: 11/12/2022] Open
Abstract
After incomplete spinal cord injury (iSCI), the control of lower extremity movements may be affected by impairments in descending corticospinal tract function. Previous iSCI studies demonstrated relatively well-preserved movement control during simple alternating dorsi- and plantarflexions albeit with severely reduced motor strength and range of motion. However, this task required comparably limited fine motor control, impeding the sensitivity to assess the modulatory capacity of corticospinal control. Therefore, we introduced a more challenging ankle motor task requiring complex and dynamic feedback-based movement adjustments to modulate corticospinal drive. Nineteen individuals with iSCI and 22 control subjects performed two different ankle movement tasks: i) a regular, auditory-guided ankle movement task at a constant frequency as baseline assessment, and ii) an irregular, visually-guided ankle movement task following a predefined trajectory as a more challenging motor task. Both tasks were performed separately and in a randomised order. Electromyography (EMG) and kinematic data were recorded. EMG frequency characteristics were investigated using wavelet transformations. Control participants exhibited a shift of relative EMG intensity from higher (>100Hz) to lower frequencies (20-60Hz) comparing the regular with the irregular movement task. There is evidence that EMG activity within these lower frequencies comprise information on corticospinal drive. The EMG frequency shift was less pronounced for the less impaired leg and absent for the more impaired leg of individuals with iSCI. The precision error during the irregular task was significantly higher for individuals with iSCI (more impaired leg: 12.34±11.14%; less impaired leg: 6.93±2.74%) compared to control participants (4.10±0.84%). These results, along with the walking performance, correlated well with the delta frequency shift between the regular and irregular movement task in the 38Hz band (corticospinal drive frequency) in the iSCI group, suggesting that task performance is related to the capacity to modulate corticospinal control. The irregular movement task holds promise as a tool for revealing further insights into corticospinal control of single-joint movements. It may serve as a surrogate marker for the assessment of modulatory capacity and the integrity of corticospinal control in individuals with iSCI early after injury and throughout rehabilitation.
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Affiliation(s)
- Adrian Cathomen
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Franziska Meier
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Irina Lerch
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Tim Killeen
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Björn Zörner
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Armin Curt
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
| | - Marc Bolliger
- Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Zurich, Switzerland;
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Fok KL, Lee JW, Unger J, Chan K, Musselman KE, Masani K. Co-contraction of ankle muscle activity during quiet standing in individuals with incomplete spinal cord injury is associated with postural instability. Sci Rep 2021; 11:19599. [PMID: 34599267 PMCID: PMC8486862 DOI: 10.1038/s41598-021-99151-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/20/2021] [Indexed: 11/09/2022] Open
Abstract
Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), soleus and medial gastrocnemius were collected bilaterally. The iSCI-group exhibited more co-contractions than the AB-group (EO: 0.208% vs. 75.163%, p = 0.004; EC: 1.767% vs. 92.373%, p = 0.016). Furthermore, postural sway was larger during co-contractions than during no co-contraction in the iSCI-group (EO: 1.405 cm/s2 vs. 0.867 cm/s2, p = 0.023; EC: 1.831 cm/s2 vs. 1.179 cm/s2, p = 0.030), but no differences were found for the AB-group (EO: 0.393 cm/s2 vs. 0.499 cm/s2, p = 1.00; EC: 0.686 cm/s2 vs. 0.654 cm/s2, p = 1.00). To investigate the mechanism, we performed a computational simulation study using an inverted pendulum model and linear controllers. An increase of mechanical stiffness in the simulated iSCI-group resulted in increased postural sway (EO: 2.520 cm/s2 vs. 1.174 cm/s2, p < 0.001; EC: 4.226 cm/s2 vs. 1.836 cm/s2, p < 0.001), but not for the simulated AB-group (EO: 0.658 cm/s2 vs. 0.658 cm/s2, p = 1.00; EC: 0.943 cm/s2 vs. 0.926 cm/s2, p = 0.190). Thus, we demonstrated that co-contractions may be a compensatory strategy for individuals with iSCI to accommodate for decreased motor function, but co-contractions may result in increased ankle mechanical joint stiffness and consequently postural sway.
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Affiliation(s)
- Kai Lon Fok
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Janelle Unger
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada. .,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Meyer C, Hofstoetter US, Hubli M, Hassani RH, Rinaldo C, Curt A, Bolliger M. Immediate Effects of Transcutaneous Spinal Cord Stimulation on Motor Function in Chronic, Sensorimotor Incomplete Spinal Cord Injury. J Clin Med 2020; 9:E3541. [PMID: 33147884 PMCID: PMC7694146 DOI: 10.3390/jcm9113541] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.
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Affiliation(s)
- Christian Meyer
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
| | - Ursula S. Hofstoetter
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
| | - Roushanak H. Hassani
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
| | - Carmen Rinaldo
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; (C.M.); (M.H.); (R.H.H.); (C.R.); (A.C.); (M.B.)
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Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE, Scivoletto G, Kleitman N, Jones LAT, Gagnon DH, Nadeau S, Haupt D, Awai L, Easthope CS, Zörner B, Rupp R, Lammertse D, Curt A, Steeves J. Lower extremity outcome measures: considerations for clinical trials in spinal cord injury. Spinal Cord 2018; 56:628-642. [PMID: 29700477 PMCID: PMC6131138 DOI: 10.1038/s41393-018-0097-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN This is a focused review article. OBJECTIVES To identify important concepts in lower extremity (LE) assessment with a focus on locomotor outcomes and provide guidance on how existing outcome measurement tools may be best used to assess experimental therapies in spinal cord injury (SCI). The emphasis lies on LE outcomes in individuals with complete and incomplete SCI in Phase II-III trials. METHODS This review includes a summary of topics discussed during a workshop focusing on LE function in SCI, conceptual discussion of corresponding outcome measures and additional focused literature review. RESULTS There are a number of sensitive, accurate, and responsive outcome tools measuring both quantitative and qualitative aspects of LE function. However, in trials with individuals with very acute injuries, a baseline assessment of the primary (or secondary) LE outcome measure is often not feasible. CONCLUSION There is no single outcome measure to assess all individuals with SCI that can be used to monitor changes in LE function regardless of severity and level of injury. Surrogate markers have to be used to assess LE function in individuals with severe SCI. However, it is generally agreed that a direct measurement of the performance for an appropriate functional activity supersedes any surrogate marker. LE assessments have to be refined so they can be used across all time points after SCI, regardless of the level or severity of spinal injury. SPONSORS Craig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.
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Affiliation(s)
- Marc Bolliger
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland.
- Swiss Center for Clinical Movement Analysis (SCMA), Zurich, Switzerland.
| | | | - Edelle C Field-Fote
- Shepherd Center, Georgia Institute of Technology, School of Biological Sciences, Emory University School of Medicine, Division of Physical Therapy, Atlanta, GA, USA
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Serge Rossignol
- Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) du CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Laurent Bouyer
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jan M Schwab
- Department of Neurology, Spinal Cord Injury Division and Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh & Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Keith E Tansey
- Methodist Rehabilitation Center, University of Mississippi Medical Center and Jackson VA Medical Center, Jackson, MS, USA
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
| | | | | | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal and Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Sylvie Nadeau
- School of Rehabilitation, Université de Montréal and Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dirk Haupt
- University of British Columbia, Vancouver, BC, Canada
| | - Lea Awai
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Chris S Easthope
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Björn Zörner
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Lammertse
- Craig Hospital, Englewood, Colorado, University of Colorado School of Medicine, Colorado, USA
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
- Swiss Center for Clinical Movement Analysis (SCMA), Zurich, Switzerland
| | - John Steeves
- University of British Columbia, Vancouver, BC, Canada
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5
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Awai L, Bolliger M, Ferguson AR, Courtine G, Curt A. Influence of Spinal Cord Integrity on Gait Control in Human Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:562-72. [PMID: 26428035 DOI: 10.1177/1545968315600524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Clinical trials in spinal cord injury (SCI) primarily rely on simplified outcome metrics (ie, speed, distance) to obtain a global surrogate for the complex alterations of gait control. However, these assessments lack sufficient sensitivity to identify specific patterns of underlying impairment and to target more specific treatment interventions. Objective To disentangle the differential control of gait patterns following SCI beyond measures of time and distance. Methods The gait of 22 individuals with motor-incomplete SCI and 21 healthy controls was assessed using a high-resolution 3-dimensional motion tracking system and complemented by clinical and electrophysiological evaluations applying unbiased multivariate analysis. Results Motor-incomplete SCI patients showed varying degrees of spinal cord integrity (spinal conductivity) with severe limitations in walking speed and altered gait patterns. Principal component (PC) analysis applied on all the collected data uncovered robust coherence between parameters related to walking speed, distortion of intralimb coordination, and spinal cord integrity, explaining 45% of outcome variance (PC 1). Distinct from the first PC, the modulation of gait-cycle variables (step length, gait-cycle phases, cadence; PC 2) remained normal with respect to regained walking speed, whereas hip and knee ranges of motion were distinctly altered with respect to walking speed (PC 3). Conclusions In motor-incomplete SCI, distinct clusters of discretely controlled gait parameters can be discerned that refine the evaluation of gait impairment beyond outcomes of walking speed and distance. These findings are specifically different from that in other neurological disorders (stroke, Parkinson) and are more discrete at targeting and disentangling the complex effects of interventions to improve walking outcome following motor-incomplete SCI.
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Affiliation(s)
- Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Adam R Ferguson
- Brain and Spinal Injury Center (BASIC), University of California - San Francisco (UCSF), CA, USA
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
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Pinheiro MDB, Menezes KKPD, Teixeira-Salmela LF. Review of the psychometric properties of lower limb motor coordination tests. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Adequate motor coordination (MC) of the lower limbs is essential for most of the motor tasks. Therefore, it is important to know the psychometric properties of the tests employed to assess lower limb MC, so that professionals could have a better basis to choose the most adequate assessment tools. Objectives To investigate the psychometric properties and clinical utility of instruments used to assess lower limb MC, by means of a critical review of the literature. Materials and methods A search was conducted in six databases looking for studies which evaluated reliability, validity, sensitivity to changes, or clinical utility of the tests employed to assess lower limb MC. The articles were assessed and the data of their psychometric properties were extracted by two researchers, independently. Results The search returned 1361 studies, 1,325 were excluded after analyses. The hand search yielded four eligible articles, totaling nine included articles. The included studies evaluated the psychometric properties of eight tests, but only three were specific to assess lower limb MC and the others were sub-items of other scales, which assess other domains. None of the tests provided data for all of the basic psychometric properties. Final remarks According to the results of this review, none of the tests had their basic psychometric properties reported, which is necessary to be investigated in future studies. This review may facilitate the search and selection of lower limb MC tests by researchers and clinicians.
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Varoqui D, Niu X, Mirbagheri MM. Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury. J Neuroeng Rehabil 2014; 11:46. [PMID: 24684813 PMCID: PMC3974744 DOI: 10.1186/1743-0003-11-46] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities-characterized by increases in the over-ground walking speed and endurance-is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. METHODS Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient's maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients. RESULTS After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments. CONCLUSIONS The improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI.
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Affiliation(s)
- Deborah Varoqui
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Xun Niu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Mehdi M Mirbagheri
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
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Tomita Y, Usuda S. Temporal motor coordination in the ankle joint following upper motor neuron lesions. J Phys Ther Sci 2013; 25:539-44. [PMID: 24259798 PMCID: PMC3804970 DOI: 10.1589/jpts.25.539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/18/2012] [Indexed: 12/02/2022] Open
Abstract
[Purpose] We compared ankle temporal motor coordination between stroke, spinal disease
and healthy elderly groups, and investigated the relationship between motor impairments
and gait speed. [Subjects] Twenty-four patients with stroke, 19 post-operative spinal
disease patients and 17 healthy elderly subjects participated. [Methods] Ankle temporal
motor coordination of the three groups was assessed using the simple reaction time, the
foot-tapping test, and a rhythm task. Rhythm error and rhythm variation were analyzed
using the results of the rhythm task. Isometric muscle strength, spasticity, muscle
stiffness, somatosensory and 10-m gait speed of the stroke and spinal disease subjects
were also measured. [Results] Only the stroke group showed significant reductions in
temporal accuracy and consistency in the rhythm task. Simple reaction time and the rhythm
task were significantly poorer in the stroke group, whereas the foot-tapping test was not.
Stepwise multiple regression analysis indicated gait speed was explained by rhythm error
and plantarflexor strength in the stroke group, and rhythm error and simple reaction time
in the spinal disease group. [Conclusion] Poor performance in simple reaction time and the
rhythm task in the stroke group suggest these tasks are controlled by the supraspinal
central nervous system. Negative features, particularly motor coordination, are more
associated with gait speed than positive features.
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9
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Corti M, McGuirk TE, Wu SS, Patten C. Differential Effects of Power Training Versus Functional Task Practice on Compensation and Restoration of Arm Function After Stroke. Neurorehabil Neural Repair 2012; 26:842-54. [DOI: 10.1177/1545968311433426] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Improved upper-extremity (UE) movement with stroke rehabilitation may involve restoration of more normal or development of compensatory movement patterns. Objective. The authors investigated the differential effects of functional task practice (FTP) and dynamic resistance training (POWER) on clinical function and reaching kinematics in an effort to distinguish between mechanisms of gains. Methods. A total of 14 hemiparetic individuals were randomly assigned to 10 weeks of either FTP or POWER and then crossed over to 10 weeks of the alternate treatment. Treatment order A was FTP followed by POWER, whereas treatment order B was POWER followed by FTP. Evaluation before and after each treatment block included a battery of clinical evaluations and kinematics of paretic UE functional reach to grasp. Results. Both FTP and POWER improved movement accuracy, as revealed by a shift toward normal, including fewer submovements and reduced reach-path ratio. However, active range of motion revealed differential treatment effects. Shoulder flexion and elbow extension decreased with FTP and were associated with increased trunk displacement. In contrast, shoulder flexion and elbow extension excursion increased with POWER and were associated with significantly reduced trunk displacement. Treatment order B (POWER followed by FTP) revealed greater overall improvements. Conclusion. FTP increases compensatory movement patterns to improve UE function. POWER leads to more normal movement patterns. POWER prior to FTP may enhance the benefits of repetitive task practice.
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Affiliation(s)
- Manuela Corti
- Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Program in Rehabilitation Sciences, University of Florida, Gainesville, FL, USA
| | - Theresa E. McGuirk
- Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Carolynn Patten
- Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Program in Rehabilitation Sciences, University of Florida, Gainesville, FL, USA
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
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10
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Clinical neurophysiology in the prognosis and monitoring of traumatic spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:63-75. [PMID: 23098706 DOI: 10.1016/b978-0-444-52137-8.00004-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Preclinical studies for the repair of spinal cord injury (SCI) and potential therapies for accessing the inherent plasticity of the central nervous system (CNS) to promote recovery of function are currently moving into the translational stage. These emerging clinical trials of therapeutic interventions for the repair of SCI require improved assessment techniques and quantitative outcome measures to supplement the American Spinal Injuries Association (ASIA) Impairment Scales. This chapter attempts to identify those electrophysiological techniques that show the most promise for provision of objective and quantitative measures of sensory, motor, and autonomic function in SCI. Reviewed are: (1) somatosensory evoked potentials, including dermatomal somatosensory evoked potentials, and the electrical perceptual threshold as tests of the dorsal (posterior) column pathway; (2) laser evoked potentials and contact heat evoked potentials as tests of the anterior spinothalamic tract; (3) motor evoked potentials in limb muscles, in response to transcranial magnetic stimulation of the motor cortex as tests of the corticospinal tract, and the application of the technique to assessment of trunk and sphincter muscles; and (4) the sympathetic skin response as a test of spinal cord access to the sympathetic chain.
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Ellaway P, Kuppuswamy A, Balasubramaniam A, Maksimovic R, Gall A, Craggs M, Mathias C, Bacon M, Prochazka A, Kowalczewski J, Conway B, Galen S, Catton C, Allan D, Curt A, Wirth B, van Hedel H. Development of quantitative and sensitive assessments of physiological and functional outcome during recovery from spinal cord injury: A Clinical Initiative. Brain Res Bull 2011; 84:343-57. [DOI: 10.1016/j.brainresbull.2010.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 08/11/2010] [Accepted: 08/12/2010] [Indexed: 01/30/2023]
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Ovechkin A, Vitaz T, de Paleville DT, Aslan S, McKay W. Evaluation of respiratory muscle activation in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2010; 173:171-8. [DOI: 10.1016/j.resp.2010.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 07/27/2010] [Accepted: 07/30/2010] [Indexed: 11/24/2022]
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Rudhe C, van Hedel HJA. Upper Extremity Function in Persons with Tetraplegia: Relationships Between Strength, Capacity, and the Spinal Cord Independence Measure. Neurorehabil Neural Repair 2009; 23:413-21. [DOI: 10.1177/1545968308331143] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To quantify the relationship between the Spinal Cord Independence Measure III (SCIM III), arm and hand muscle strength, and hand function tests in persons with tetraplegia. Methods. A total of 29 individuals with tetraplegia (motor level between cervical 4 and thoracic 1; sensory-motor complete and incomplete) participated. The total score, category scores, and separate items of the SCIM III were compared to the upper extremity motor score (UEMS), an extended manual muscle test (MMT) for 11 upper extremity muscles, and 6 functional capacity tests of the hand. Spearman's correlation coefficients ( rs) and regression analyses were performed. Results. The SCIM III sum score correlated well with the sum scores of the 3 tests ( rs ≥ .76). The SCIM III self-care category correlated better with the tests ( rs ≥ .80) compared to the other categories ( r s ≤ .72). The SCIM III self-care item “grooming” highly correlated with muscle strength and hand capacity items ( rs ≥ .80). A combination of hand muscle tests and the key grasping task explained over 90% of the variability in the self-care category scores. Conclusions. The SCIM III self-care category reflects upper extremity performance as it contains especially useful and valid items that relate to upper extremity function and capacity tests.
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Affiliation(s)
- Claudia Rudhe
- The GRASSP Study Group (Graded Redefined Assessment of Strength, Sensibility, and Prehension), EM-SCI Study Group (European Multicenter Study on Human Spinal Cord Injury), Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Hubertus J. A. van Hedel
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland, , EM-SCI Study Group (European Multicenter Study on Human Spinal Cord Injury)
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Ankle paresis in incomplete spinal cord injury: relation to corticospinal conductivity and ambulatory capacity. J Clin Neurophysiol 2008; 25:210-7. [PMID: 18677185 DOI: 10.1097/wnp.0b013e318183f4e3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is limited data on the relation of corticospinal tract conductivity to clinical measures in incomplete spinal cord injury. This study examined the relationship of muscle strength to corticospinal tract input assessed by motor evoked potentials (MEPs) during static and dynamic conditions and to gait. Dorsiflexor strength was established by manual muscle test, maximal voluntary contraction, and maximal movement velocity, the latter being acquired during auditory-paced ankle movements. MEPs were elicited during isometric contractions with constant or continuously increasing ankle joint torque. Gait was assessed by quantifying its speed and independence. Linear regression analyses showed that maximal movement velocity was related to the MEP latencies and amplitudes in the dynamic condition (R(2)(adj.) = 0.62) and to the MEP latencies in the static condition (R(2)(adj.) = 0.45). Maximal voluntary contraction was only related to the MEP latencies in the static (R(2)(adj.) = 0.45) and the dynamic condition (R(2)(adj.) = 0.21), whereas manual muscle test did not show any relationship to the MEPs. In incomplete spinal cord injury patients, the dynamic measure maximal movement velocity might be a useful clinical assessment of corticospinal tract function. Clinical studies on recovery and repair of corticospinal tract function in spinal lesions could substantially benefit from implementing dynamic measures in the clinical assessment protocol.
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Ankle dexterity remains intact in patients with incomplete spinal cord injury in contrast to stroke patients. Exp Brain Res 2008; 191:353-61. [DOI: 10.1007/s00221-008-1528-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
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