Ambulation and Upright Mobility

evidence based prognostic factors involved in walking prognosis

ISNCSCI, AIS grade, level of injury

walking with AIS A

few recover, typically lower thoracic or lumbar lesions, use AD, slower pace

walking with AIS B

33%, better prognosis with preservation of pin prick (and light touch)

approximately how many AIS B convert to AIS C/D

50%

walking with AIS C

75% recover, use AD and bracing

best prognosis for walking recovery

AIS D with diagnosis within 72 hours

factor of age in walking recovery

higher recovery rate for people less than 50 years old

central cord syndrome walking prognosis

excellent

brown-sequard syndrome walking prognosis

75% achieve ambulation

anterior cord syndrome walking prognosis

few recover

posterior cord syndrome walking prognosis

rare but limited evidence

why does a penetrating/traumatic SCI have a worse walking prognosis

because there is a higher chance of a complete SCI

location with worst walking prognosis

thoracic spine due to increased likelihood of a complete SCI

other benefits of gait training that is not for recovery of walking

help CV system, increase bone mineral density, decrease pressure injury, improve ROM to prevent contracture, manage spasticity, psychological benefits

CPG for locomotor function post SCI

mod-high intensity aerobic training (60-80% HRR, 7-9/10 RPE), variety of contexts and challenges

ingredients of neuroplasticity used in gait training

variability, intensity, specificity, repetition

why does intensity matter in locomotor training

high intensity increases neural drive which is critical for neuroplasticity

individual considerations prior to initiating gait training

OH, ROM, spasticity

WHO quality of life BREF

measures QoL in a wheelchair

walking index for SCI II (WISCI)

ordinal scale that assigns levels of walking based on devices, braces, and assistance

reason to use crutches/cane over RW

work on trunk stability, better access to stairs

reason to use RW over crutches/cane

more stability, decreases metabolic cost

reasons to use wheelchair over walking

lower energy cost, reduces fall risk, can use UE for other tasks, faster, enables participation in higher levels of activity