Spinal Cord IV

Impact of spinal cord injury

• decreased number of motor units, rate of force development, power, stride rate

• impaired balance/postural control

• impaired coordination

prognostic predictors for locomotor training

Independent walking probability, FIM independence predictor

Independent walking probability is for

10 m indoors @ 1 year

independent walking probability is also called

Van Middendorp and colleagues CPR

for independent walking probability you apply

only the best score for motor/sensory between both sides

levels used in independent walking probability

L3 and S1

propriospinal neurons are

interneurons only located in the SC

propriospinal neurons can be

short or long, and ipsilateral or commissural

propriospinal neurons convery

modulating sensory and motor info between SC levels

somatotropin localization within SC for propriospinal neurons

medial - axial and proximal, lateral - distal

unregulated genetic expression after SCI can lead to

new synapse formation, axonal regrowth, and improved growth cone dynamics

SPGs

group of cells in lumbosacral SC that store rhythmic flx/ext pattern of walking, composed of sensory neurons, motoneurons, and interneurons

SPGs modulated by

supra spinal networks and afferent sensory info

there is a theorized connection of propriospinal neurons to

SPGs

no evidence to support

SPG autonomy in humans or primates (cortical dominance)

principles of locomotor training

maximize LE WB and recovery strategies, optimize sensory cues and kinematics,

with decreased UE support there is

increased LE EMG activity

optimizing sensory cues for locomotor training

normal walking speed

optimizing kinematics for locomotion

hip ext and weight shift crticial

in motor complete you should prioritize

recovery training before compensatory gait

methods for locomotor training

Body weight supported treadmill training (BWSTT), overground gait training (OGT), Robot assisted gait training (RAGT)

examples of locomotor tech

lite gait, Ekso, Lokomat

BWSTT vs OGT

OGT slightly better for speed

locomotor CPG

moderate-high intensity task-specific training and VR, cross training has not help too much, don’t use BWSTT or RAGT or balance trng /s augmented feedback

limitations to locomotor CPG

speed and distance only parameters considered, they were already ambulatory, didn’t consider acute phase

for locomotor trng clinicians should

walk trng at mod to high aerobic intensity, walk trng /c VR

for locomotor trng clinicians may

strength train ≥70% 1RM, circuit trng, cycling, recumbent step 75-85% HRmax, balance /c VR

for locomotor trng clinicians shouldn’t

static or dynamic balance/pregait /c intent of speed/distance, BWSTT /c kinematic emphasis, RAGT

restorative gait trng principles

specificity, repetition, intensity, salience

mod to high intensity

60-80% HRR, 70-85% HR max

Target HR

(Max-resting x intensity) +restingHIGT

HIGT

walk/stepping practice characterized by high number of steps per session and high aerobic intensity

aerobic trng has higher risk of

morbidity and mortality

HIGT does not need to be

on a treadmill

absolute contraindications for HIGT

ECG suggesting ischemia, unstable angina, uncontrolled dysrhythmias causing sx/changes, symptomatic severe aortic stenosis, uncontrolled symptomatic heart failure, acute myocardial/pericarditis, suspected or known dissecting aneurysm, acute systemic infection /c sx

HIGT zones rely on

age adjusted max HR predictive equations or heart rate reserve

post-cva exercise guidelines

40-70% HRR

if HR max not available keep RPE

11-14

do not rely on

AAHR max

non-motor benefits of locomotor trng,

reduced nocturne, incontinence, defecation time, complete resolution of fecal incontinence, increase in sexual desire, improved performance, BP regulation, bone health, m bulk maintenance

4 subcomponents and criteria of gait

stance control, limb advancement, propulsion, postural stability

SCI pts should do

20 min aerobic 2x/week and 3 sets each m group 2x/week, but also 30 min aerobic 3x/week