Gait variability following abrupt removal of external stabilization decreases with practice in incomplete spinal cord injury but increases in non-impaired individuals.
Mengnan Mary Wu, Geoffrey L Brown, Kwang-Youn A Kim and 2 others
PMID 30612582WHAT IT FOUND
Practice reduced gait variability after abrupt loss of lateral support in people with incomplete spinal cord injury.
Non-impaired people showed increased gait variability with practice and lower hip muscle activity.
Key findings
01During the first abrupt removal of lateral stabilization, participants with incomplete spinal cord injury had increased variability in center-of-mass speed, center-of-mass excursion and step width compared with unassisted baseline walking, but by the third transition their variability was no longer different from baseline.
02Non-impaired participants did not show the same recovery with practice; their variability of lateral center-of-mass excursion increased during later transitions compared with baseline.
03Non-impaired participants reduced hip abductor muscle activity from the first to the third transition, while participants with incomplete spinal cord injury showed no significant change in hip abductor activity.
STILL TO COME
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What it does not show
The study was small, with 13 participants with incomplete spinal cord injury and 12 non-impaired participants, and one participant with incomplete spinal cord injury was excluded from analysis. Only 9 non-impaired participants and 6 participants with incomplete spinal cord injury had usable hip muscle activity data, so muscle findings are less reliable. Participants with incomplete spinal cord injury were all AIS D and had to walk 10 m without assistive devices, so the findings may not apply to people with more severe walking impairment. The stabilizing force field is a laboratory method and is not a typical gait rehabilitation intervention. The groups were not age or gender matched, and the study did not directly compare them statistically, so differences between groups cannot be treated as a controlled group comparison. The analysis used the transition length from the first transition for all transitions because the later transitions were highly variable and did not fit a consistent model. Some participants did not return to steady state within the 100 unassisted steps after the field was removed, so the analysis period may have missed ongoing instability. Research personnel provided physical support to some participants with incomplete spinal cord injury for safety, which may have improved control and reduced muscle effort. Participants were told to walk comfortably and center their midline over a chalk line, but their interpretation and motivation may have affected how much effort they used to control variability.
Declared interests
The supplied article text does not report a funding source or author conflict-of-interest statement. The supplied publication types list research support from U.S. Gov't, non-P.H.S.
The easy way to misread this
Do not conclude that practice of abrupt support removal improves stability for everyone. Participants with incomplete spinal cord injury showed less variability after practice, but non-impaired participants showed more variability while using less hip muscle activity.