Immediate effects of obstacle crossing training in independent ambulatory patients with spinal cord injury

Abstract

Study design: A 2 Â 2 cross-over design. Objectives: To compare immediate effects of obstacle crossing training and conventional overground walking training on functional ability among independent ambulatory patients with spinal cord injury (SCI). Setting: A tertiary rehabilitation center, Thailand. Methods: Twenty independent ambulatory participants with SCI received a 1-day overground walking training and a 1-day obstacle crossing training program in a randomized cross-over design with a 2-day washout period. Immediately prior and after each training program, the functional ability of all participants was measured using the timed up and go test (TUGT), five times sit-to-stand test (FTSST) and 10-m walk test (10MWT). Results: The TUGT, FTSST and 10MWT data were significantly better after obstacle crossing training (Po0.001) but not after the overground walking training (P40.05). The improvement following obstacle crossing training was also significantly different from that of the overground walking training (Po0.05). Conclusion: Obstacle crossing training immediately enhanced functional ability related to walking of ambulatory participants with SCI. However, a further longitudinal study using a randomized controlled trial is needed to support benefits of incorporation of obstacle crossing training into rehabilitation practice.

Validation of the Brazilian version of the Spinal Cord Independence Measure III

“…This occurs because the SCIM III scores more levels of locomotion and transference, even when the individual already performs this task without any help. It is noteworthy that despite being the standard instrument for functional evaluation of individuals with spinal cord injuries, the FIM TM shows a ceiling effect that can be overcome by measuring gait with other instruments 19 . However, for tetraplegic individuals, the difference is at the lower extremity of the curve, where the SCIM III can perceive variations for lower scores even if the individual has the lowest FIM TM score, because only the SCIM III evaluates breathing, which can be severely compromised in persons with these levels of spinal cord injury, compromising their inhaling and coughing independently or even with the use of ventilators 20 .…”

Dual-Task Obstacle Crossing Training Could Immediately Improve Ability to Control a Complex Motor Task and Cognitive Activity in Chronic Ambulatory Individuals With Spinal Cord Injury

“…Following the first training session, participants went through a 2-day washout period. 9 Confirmation that carryover effects did not occur was established by Grizzle method 9 and data from 10 pilot cases. On the fifth day, participants were involved in the other training program.…”

“…The sample size calculation indicated that each training program required 22 participants. A 10-Meter Walk Test (10MWT) was set as a major outcome of the study, and the study used the magnitude of effect sizes from a recent study 9 (μ1 -μ2 = 0.10, σ = 0.09, α = 0.05, and β = 0.10). The inclusion criteria were an age of at least 18 years old, a body mass index between 18.50 and 29.90 kg/m 2 , and a motor incomplete lesion (American Spinal Injury Association Impairment Scale [AIS] C and D) from trauma or nonprogressive disease with a postinjury time of at least 12 months.…”

“…The inclusion criteria were an age of at least 18 years old, a body mass index between 18.50 and 29.90 kg/m 2 , and a motor incomplete lesion (American Spinal Injury Association Impairment Scale [AIS] C and D) from trauma or nonprogressive disease with a postinjury time of at least 12 months. 9 The eligible participants also needed the ability to walk independently for over at least 17 meters with or without assistive devices (FIM locomotor scores 5 to 7) and the ability to read Thai. The participants were excluded if they could not complete a training program or had a condition that might affect their participation in the study, such as pain in the musculoskeletal system with a level of pain more than 5 out of 10 on a visual analog scale, deformity in the joints that affected ambulatory ability, or color blindness.…”

“…Obstacle crossing training is an effective challenging activity for ambulatory individuals with SCI. 9 Four obstacles of varying sizes (4 cm wide, 8 cm wide, 4 cm high, and 8 cm high) were randomly placed along a 10-meter walkway at 2-meter intervals ( Figure 1A). Participants walked at a comfortable speed with or without a walking device according to their usual manner.…”