Improvements in skilled walking associated with kinematic adaptations in people with spinal cord injury.
Raza N Malik, Gevorg Eginyan, Andrea K Lynn and 1 others
PMID 31455357WHAT IT FOUND
Following Lokomat-based treadmill training in 8 people with motor-incomplete spinal cord injury, changes in how the weaker hip and ankle moved together and less knee range of motion were linked to better obstacle and stair walking.
They were not linked to faster 10-metre walking.
Key findings
01Better skilled walking after training was significantly associated with less knee range of motion on the weaker limb (ρ = .833, p = 0.010).
02Better skilled walking after training was significantly associated with larger change in weaker-limb hip-ankle coordination (ρ = -.833, p = 0.010).
03No relationship was observed between changes in walking speed and any kinematic variable.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 8 of the 13 people who completed the original pilot trial had usable kinematic data; the other 5 were excluded for missing recordings or sessions. This is a secondary analysis of a small pilot trial, not a large randomised trial, so it cannot show that these movement changes caused better walking. Movement data were collected during treadmill walking with body-weight support, but walking skill and speed were measured over ground without body-weight support. Participants had to be able to walk on a treadmill with body-weight support without manual assistance, so the findings may not apply to people with more severe injury. The training was delivered as a Lokomat-based treadmill program with body-weight support, and the paper does not separate the contribution of any single component. The able-bodied comparison group had only 5 participants.
Declared interests
The Canadian Institutes of Health Research funded the work. The supplied text does not state that the funder designed or wrote the study.
The easy way to misread this
Do not read this as proof that Lokomat training improves walking by changing hip-ankle coordination or knee range of motion. It is a small secondary analysis of 8 people, and it only reports associations after training; no causal link was tested.