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

Abstract

Background. Walking speed is assumed to be a key factor in regaining ambulation after spinal cord injury (SCI). However, from the literature it remains unclear which walking speed usually results in independent community ambulation. Objective. The primary aim of this study was to determine at which walking speed SCI patients tend to walk in the community instead of using a wheelchair. The secondary aim was to investigate clinical conditions that favor independent ambulation in the community. Methods. Data from SCI patients were collected retrospectively from the European Multicenter Study about Spinal Cord Injury database. We determined a cutoff walking speed at which the patients tend to walk in the community by plotting a receiver operating characteristics curve, using the Spinal Cord Independence Measure for outdoor mobility. Univariate analyses investigated which factors influence independent community ambulation. Results. A walking speed of 0.59 m/s is the cutoff between patients who do and do not ambulate independently in the community, with a sensitivity of 91.6% and a specificity of 80.3%. Age, injury severity, and lower limb muscle strength have a significant influence on independent community ambulation. Conclusions. Patients with an SCI who regain a walking speed of 0.59 m/s tend to achieve a level of walking effectiveness that allows for independent community walking. Although such patients tend to be younger and less severely injured, this walking speed can be a target for locomotor training in rehabilitation and clinical trials that lead to a meaningful outcome level of community walking.

The Ability to Walk After a Spinal Cord Injury with Emphasis on Exoskeletons: A Review

“…However, for community ambulation, it is necessary to be able to achieve a walking speed of at least 0.49 m/s, which is necessary, for example, to cross an intersection as set by traffic signals [53]. Another study showed that a walking speed of 0.59 m/s is feasible for patients to prefer walking over using their wheelchair whilst ambulating in the community [27]. This might make exoskeletons for now an unsuitable method of ambulation in the community for most SCI patients without sufficient ambulatory function on their own.…”

“…This means that in patients with SCI, the preferred walking speed as assessed in the clinic can be used to estimate functional ambulation during daily life. Another study showed that SCI patients who have a walking speed of 0.59 m/s on the 10 MWT tend to walk in the community instead of using their wheelchair [26,27]. However, the actual walking speed depends on many factors such as the motivation of the subject as well as environmental and psychological factors.…”

“…However, the actual walking speed depends on many factors such as the motivation of the subject as well as environmental and psychological factors. Another study showed that a combination of walking velocity and knee-extension strength is a good discriminant between household and community walkers, with a threshold of 0.42 m/s for the velocity variable [26,27].…”

“…This prediction is based on a combination of factors including age, motor scores of the quadriceps femoris and the gastrocsoleus muscles, and light touch sensation for two dermatomes (L3 and S1). This prediction rule has been validated externally [27] when being used in daily clinical practice and has shown to be accurate in giving an early prognosis in the first two weeks after a SCI.…”

Improvements in skilled walking associated with kinematic adaptations in people with spinal cord injury

“…Gait rehabilitation strategies for people with m-iSCI have been built upon principles of providing appropriate (walking-related) afferent feedback to central locomotor circuits (‘pattern generators’) within the spinal cord [13–16]. Systematic reviews of repetitive practice of walking, whether over-ground or on a treadmill, and assisted by robotics or a therapist, have revealed modest improvements in lab-based measures of walking speed and endurance [17–20] that do not necessarily translate to better community ambulation [11, 12].…”