Walking after spinal cord injury: Evaluation, treatment, and functional recovery

Barbeau, Hugues; Ladouceur, Michel; Norman, Kathleen E.; Pépin, André; Leroux, Alain

doi:10.1016/s0003-9993(99)90126-0

Cited by 181 publications

(87 citation statements)

References 94 publications

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“…Walking function, however, is a very complicated activity, which may be affected by many factors. 12 Motor scores alone do not correlate completely with increased walking function, because other factors such as age, 4 pain, 30,31 balance, 32,33 spasticity, 34 overweight 35 and possibly duration of training may effect walking function. In fact in our patients, motor scores alone show a significant (r ¼ 0.57, Po0.001), but not complete correlation with the WISCI.…”

Section: Discussionmentioning

confidence: 99%

“…9 Recovery of locomotion, therefore, has become a primary goal of both pharmacological and rehabilitative treatment. In the last decade, pharmacological treatment 10 and rehabilitative approaches 11,12 have been initiated to enhance locomotion capacity of SCI patients. Basic science advances 13 in regeneration of the central nervous system hold promise of further neurological and functional recovery to be studied in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

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Walking index for spinal cord injury (WISCI): criterion validation

et al. 2004

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Study design: Retrospective examination. Objectives: To compare the Walking Index for Spinal Cord Injury (WISCI) and current scales for their sensitivity to walking changes in subjects with a spinal cord lesion (SCL) and further validate the WISCI for use in clinical trails. Setting: A large rehabilitation hospital in the center of Italy. Patients and methods: Retrospective review was performed on 284 patient records with an SCL. Measurements included neurological evaluation with Lower Extremity Motor Scores (LEMS) according to the American Spinal Injury Association (ASIA) and walking status assessed by Barthel Index (BI (0-15)), Rivermead Mobility Index (RMI (three levels)), Functional Independence Measure (FIM (1-7)), Spinal Cord Independence Measure (SCIM (0-8)), and WISCI (0-20). The WISCI is a 21-level hierarchical scale which incorporates gradations of physical assistance and devices required for walking. Improvement in walking is based on the change of scores from admission to discharge. Statistical analysis included Spearman rank correlation and w 2 test; Po0.05. Results: There was a significant positive correlation between WISCI and other scales (WISCI and BI r ¼ 0.67, Po0.001; WISCI and RMI r ¼ 0.67, Po0.001; WISCI and SCIM r ¼ 0.97, Po0.001; WISCI and FIM r ¼ 0.7, Po0.001). The initial ASIA grade was predictive of mobility outcome on the WISCI: of the 78 ASIA A patients, only five achieved independent walking versus 4/17 ASIA B (P ¼ 0.02), 56/109 ASIA C (Po0.001) and 39/44 ASIA D (Po0.001). The correlation of LEMS to the WISCI was 0.58 (Po0.001). At discharge, patients were distributed into 12 WISCI levels versus four FIM, three BI, two RMI and five SCIM levels. The most frequent WISCI levels at discharge were 13 (walker, no braces or assistance), 16 (two crutches, no braces or assistance) and 20 (no devices or assistance). Conclusions: Similar correlation between the WISCI and the other scales indicates that all these measures address the same concept, mobility, which is a measure of concurrent validity. The correlation is not 100% because of conceptual differences (the WISCI incorporates gradations of physical assistance and devices required for walking while most of the other scales focus on burden of care or mobility in the environment). The WISCI is more detailed and appears more sensitive to walking recovery than the other scales, as demonstrated by our patients' score distribution at discharge. Within each of the most frequent WISCI levels (13,16,20) LEMS and other walking features varied; therefore the scale would benefit from further refinement based on speed, distance and energy cost.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Walking index for spinal cord injury (WISCI): criterion validation

et al. 2004

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“…It is considered essential for functional ambulation of traumatic spinal cord injury patients. 23,24 The importance of plantar flexor muscles, however, has been minimized. 25 The role of this muscle group in the gait cycle, being active in weight acceptance (loading response and pre-swing phase), is important to progress and stability.…”

Section: Discussionmentioning

confidence: 99%

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP)

Franzoi

Araújo

2006

Spinal Cord

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Study design: Cross-sectional. Objectives: The aim of this survey is to describe the disability profile in a group of tropical spastic paraparesis/HTLV-I-associated myelopathy patients, identifying the requirements for community ambulation. Setting: Terciary care unit, Rio de Janeiro, Brazil. Methods: Seventy-two patients were assessed (49 female and 23 male), referred by tertiary care centers, when a clinical protocol was applied. Results: The sample had an average age of 40 years and an average of 137 months of duration of the disease. The most prevalent aspects of disability found were in gait and sphincter control areas. A total of 72% of the patients were community ambulators and 17% were restricted to wheel chair. Age, strength and low-back pain interfere in activities of daily living (Po0.05). A positive correlation was found between community ambulation and the knee extensors (r ¼ 0.80) and ankle plantar flexors (r ¼ 0.74). Strength, age, low-back pain, duration of disease, asymmetric onset of the symptoms and spasticity interfered in the ability to walk (Po0.05). A rehabilitation program was proposed focusing on modifiable factors that affect disability level. Conclusion: It was possible to describe the profile of disability in this group of patients, identifying the requirements to the community ambulation. Sponsorship: Not applicable.Spinal Cord (2007) 45, 64-68.

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“…Locomotor therapy with body weight support (BWS) is an effective tool in rehabilitation that may help patients regain the ability to walk (Barbeau, Ladouceur, Norman, Pepin, & Leroux, 1999;Dietz & Colombo, 2004;Edgerton, Kim, Ichiyama, Gerasimenko, & Roy, 2006;Grasso et al, 2004;Schmidt, Werner, Bernhardt, Hesse, & Krüger, 2007;Scivoletto et al, 2007). Foot-support interactions and appropriate sensory signals are an integral part of the rhythm-generating networks (Duysens, Clarac, & Cruse, 2000).…”

Section: Introductionmentioning

confidence: 99%

A novel approach to mechanical foot stimulation during human locomotion under body weight support

Gravano

Ivanenko

Maccioni

et al. 2011

Human Movement Science

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a b s t r a c tInput from the foot plays an essential part in perceiving support surfaces and determining kinematic events in human walking. To simulate adequate tactile pressure inputs under body weight support (BWS) conditions that represent an effective form of locomotion training, we here developed a new method of phasic mechanical foot stimulation using light-weight pneumatic insoles placed inside the shoes (under the heel and metatarsus). To test the system, we asked healthy participants to walk on a treadmill with different levels of BWS. The pressure under the stimulated areas of the feet and subjective sensations were higher at high levels of BWS and when applied to the ball and toes rather than heels. Foot stimulation did not disturb significantly the normal motor pattern, and in all participants we evoked a reliable step-synchronized triggering of stimuli for each leg separately. This approach has been performed in a general framework looking for ''afferent templates" of human locomotion that could be used for functional sensory stimulation. The proposed technique can be used to imitate or partially restore surrogate contact forces under body weight support conditions.

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Walking after spinal cord injury: Evaluation, treatment, and functional recovery

Cited by 181 publications

References 94 publications

Walking index for spinal cord injury (WISCI): criterion validation

Walking index for spinal cord injury (WISCI): criterion validation

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP)

A novel approach to mechanical foot stimulation during human locomotion under body weight support

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