Locomotor training restores walking in a non ambulatuory child with chronic,severe,incomplete cervical spinal cord injury

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Locomotor training restores walking in a non
ambulatuory child with chronic,severe,incomplete
cervical spinal cord injury

• Andrea Behrman PT PhD
• University of Florida
• Dr. Asmita Karajgi
• Associate Professor
• Dept of Physiotherapy
• Pad. Dr. D Y Patil University
• Nerul, Mumbai

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Locomotor training

• Promising experimental approach
• Improves speed
• endurance
• step symmetry
• obstacle negotiation

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A single case study-pretest-posttest design

• Case description- 4.5 yr old boy
• 16 weeks post
  injury(gunshot wound)
• low cervical
  spinal cord injury
• 3 months of
  inpatient rehabilitation10 mth of outpatient
  rehabilitation
• improved from
  AIS A to AIS C with bilat C 8 function
• a lot of
  extensor tone in quadriceps and no voluntary hip
  flexion ,ankle or toe movement
• could not
  stand independently
• 
  prognosis-wheelchair bound

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Assessment

• prior to training
• ROM
• spasticity
  (quadriceps-2 Plantar flexors-1)
• ASIA
  impairement scale(Plantar flexors-2 for each leg)

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Methodology

• 76 sessions of locomotor training
• 20-30 minutes of step training with BWS on
  treadmill followed by 10-20 minutes of overground
  training with graded sensory cues.
• Assistance at the pelvis,trunk and each lower
  limb
• Training 5 times per week 45 sessions76 sessions

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Locomotor training

• Upright posture LE weight bearing without upper
  limb weight bearing
• Limb co-ordination with arm
  swing
• Aim of approximating normal
  walking speed
• 5 min bout of step training on
  treadmill(stretches to hip flexors and
  dorsiflexors) followed by bout of stand
  training(BWS was reduced,manual pressure to knee
  and ankle extensors)
• Transfer to overground training

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Results

• ASIA SAME (AIS C with bilat C 8 function)
• Only hip flexors improved from 0 to 1 after 74
  sessions
• Locomotor recovery-
• Baseline-nonambulatory
• 22 sittings-slight activity of ext and improved
  shoulder alignment with pelvis
• After 6 sessions of intense cueing-active
  contribution to stepping
• Noncued steps
• After 18 sessions (51-76)-independent use of
  posterior rolling walker

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Results

• Walking index score from 0 to 13/20 but no change
  in LEMS
• Gait speed 0.29m/s(self selected) 0.48 (maximum
  )
• 2488 community based steps.
• Recovery only locomotor dependent

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Discussion

• SPGL-
• 2 components
• 1 using sensory input by trainers
• 2 activation of SPGL by the patient
• Cortico brainstem spinal system activation

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