Functional community ambulation requirements in incomplete spinal cord injured subjects

Abstract

Study design: A group of people with incomplete spinal cord injuries (SCI) were evaluated and compared with able-bodied individuals during several walking conditions. Objectives: To evaluate the functional community ambulation and estimated energy expenditure in persons with incomplete SCI and able-bodied individuals. Methods: A list of criteria was used to evaluate functional community ambulation among participants. Physiological variables, such as the heart rate, oxygen uptake and the lactate concentration, were also measured. Results: Three of nine incomplete SCI subjects and all able-bodied subjects were able to meet all the criteria measured. The required velocity to safely cross an intersection was the criterion that the incomplete SCI group had the most di culty reaching. The able-bodied subjects had a comfortable walking velocity twice that of the incomplete SCI subjects' preferred velocity. When walking at the same velocity (incomplete SCI subjects' preferred velocity), the incomplete SCI subjects had a rate of oxygen uptake 26% greater than the healthy subjects and were 200% less e cient. The lactate concentration also proved to be a useful tool when evaluating the incomplete SCI subjects' walking e ciency. The incomplete SCI subjects lactate concentration increased after walking at their preferred velocity, meaning that the anaerobic pathways were used to meet energy demands. Conclusion: Rehabilitation centers should adapt their evaluation forms and increase their criteria requirements to more suitable criteria that are found in the SCI patient's community. The physiological cost should also be taken into consideration when evaluating the SCI patient's functional ambulation.

Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale

“…It is worth noting that a significant number of subjects with a maximal score on the Berg scale or the WISCI had a walking speed below normal or functional value. 22,23 Thus, the maximal score on these two instruments is not necessarily indicative of the normal walking function. A timed or measured walking evaluation, such as the 10MWT, would therefore be a useful adjunct to these evaluations to further characterize higher functioning individuals.…”

Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury

“…13,14 This group of patients often presents with impairments ranging from minimal sensory and motor loss below the level of lesion to complete motor loss with sacral sparing only. 15 Skeletal muscle adaptations after acute incomplete SCI are not well documented.…”

Ten Meters Walking Speed in Spinal Cord–Injured Patients: Does Speed Predict Who Walks and Who Rolls?

“…13,14 This could be explained by the different diagnosis and patient selection, as well as the much smaller study populations than in this study: 48 cerebral stroke patients and 32 AIS D SCI patients. The preferred walking speed of the healthy population is 1.20 to 1.31 m/s, 16 which is about twice as fast as the cutoff walking speed determined in this study. The patients in this study who walk without any walking aids had a mean walking speed of 1.48 m/s, which is similar to the preferred walking speed of the healthy population.…”

“…Furthermore, it has been suggested that a walking speed of 1.20 to 1.31 m/s is required for independent ambulation in the community, since it is similar to the preferred walking speed of nonimpaired people. 16 SCI patients with limited lower extremity muscle power who are unable to bear their body weight (eg, AIS [American Spinal Injury Association Impairment Scale] A, B, and C SCI) can still walk using an exoskeleton. An exoskeleton is an orthosis with electromotors at the hip and knee joints, rechargeable batteries, and a computer-based control system.…”