Increased Lower Limb Loading During Sit-to-Stand is Important for the Potential for Walking Progression in Ambulatory Individuals with Spinal Cord Injury

Upper extremity effort during the sit-to-stand task in able-bodied and in individuals with spinal cord injury: A preliminary study

OBJECTIVE

To investigate the association between the presence of spinal cord injury (SCI) on biomechanical variables by comparing individuals with SCI and able-bodied individuals during the sit-to-stand (STS) task assisted by a walker device. Specifically, we compared the upper-extremity joint angles and moments, trunk forward tilt angle, vertical forces of the instrumented walker, and ground reaction forces between groups.

DESIGN

Case-control study.

SETTING

Department of Orthopedics and Traumatology, UNICAMP-Brazil.

PARTICIPANTS

Six individuals with SCI and fourteen able-bodied individuals.

MAIN OUTCOME MEASURES

Kinematics and kinetics of the shoulder, elbow, and wrist joints; trunk forward tilt angle, vertical walker forces, and ground reaction forces (GRF) were analyzed during the STS task in two phases: before and after the seat-off event.

RESULTS

A higher peak elbow flexion angle and higher vertical walker forces were observed before the seat-off, whereas the lower peak vertical GRF was found, after the seat-off, in the SCI group compared with the control group.

CONCLUSIONS

SCI affects kinematics and kinetics variables during the STS task compared to able-bodied controls. Individuals with SCI adopted different standing-up strategies that affected the distribution of the forces in the upper and lower extremities of the human body.

The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers

Background

The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI).

Objectives

This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional.

Methods

Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers.

Results

Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters.

Conclusion

The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury

Background:

Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability.

Objective:

This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily (n=49).

Methods:

All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance.

Results:

The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability (p<0.05). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance (ρ=−0.351 to −0.493, p<0.05).

Conclusion:

The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.