Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading.
Christopher Schmidt Easthope, Luca Renato Traini, Lea Awai and 4 others
PMID 30419945WHAT IT FOUND
In 12 people with chronic incomplete spinal cord injury who could walk at 2 km/h, overground unloading up to 50% changed walking timing and balance, but the way their leg joints moved together stayed more fixed than in controls.
Key findings
01With increasing unloading, people with chronic incomplete spinal cord injury and controls both slowed, but the patients did not lengthen steps while controls did.
02Unloading changed forward-backward posture differently: controls reduced trunk sway and increased centre-of-mass motion, while the patients did not.
03Controls changed the shape of hip-knee and knee-ankle coordination with unloading, while the patients did not; coordination variability increased in both groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 12 of 15 recruited participants with chronic incomplete spinal cord injury completed the protocol; three could not walk 20 strides at 2 km/h without unloading, so the results apply only to relatively high-functioning community ambulators. The CiSCI group was small and mixed, with different lesion levels, times since injury and mainly sensory impairments, so it is hard to tell how the findings apply to any one patient. The control group was much younger than the CiSCI group, mean 29 versus 51 years, although the analysis included age as a covariate. The study used a fixed walking speed of 2 km/h, not preferred speed, and did not test whether unloading during training improves walking function or recovery. The harness and cable robot may have influenced posture and balance, so some changes may reflect equipment interaction rather than unloading alone. Three participants had been injured for less than one year, so they were not uniformly chronic.
The easy way to misread this
Do not conclude that overground body-weight support improves walking after spinal cord injury. The study measured kinematics during a single walking task in 12 community ambulators, not rehabilitation outcomes, and it did not show functional recovery.