Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured.
DESIGN: This paper describes a treatment paradigm to facilitate functional gait in a quadriplegic, ASIA C spinal cord injured (SCI), wheelchair-dependent subject who presented with some large fiber sensation, sub-functional motor strength in all lower limb muscles, and moderate spasticity. The study...
| Publicado en: | Spinal Cord Vol. 40; no. 2; pp. 65 - 69 |
|---|---|
| Autores principales: | , , , , |
| Formato: | case study research tables/charts Journal Article |
| Publicado: |
Springer Nature
Feb2002
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106955173&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106955173 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13624393 DZQ jtl: Spinal Cord issn: 13624393 maglogo: Y pubinfo: dt: Feb2002 vid: 40 iid: 2 pid: 2579 pub: Springer Nature place: Dordrecht, <Blank> artinfo: ui: 106955173 2002091589 10.1038/sj.sc.3101263 NLM11926417 106955173 ppf: 65 ppct: 4 formats: tig: atl: Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. aug: au: Herman R He J D'Luzansky S Willis W Dilli S affil: Clinical Neurobiology and Bioengineering Research Laboratory, Good Samaritan Regional Medical Center, 1111E McDowell Road-R2, Phoenix, AZ 85006 sug: subj: Quadriplegia Electric Stimulation Electrodes, Implanted Gait Training Methods Walking Epidural Space Gait Functional Assessment Activities of Daily Living Evaluation Arizona Weight-Bearing Gait Analysis Male Adult Descriptive Statistics Comparative Studies Funding Source Human Adult: 19-44 years Male ab: DESIGN: This paper describes a treatment paradigm to facilitate functional gait in a quadriplegic, ASIA C spinal cord injured (SCI), wheelchair-dependent subject who presented with some large fiber sensation, sub-functional motor strength in all lower limb muscles, and moderate spasticity. The study utilizes partial weight bearing therapy (PWBT) followed by epidural spinal cord stimulation (ESCS) with the assumption that both treatments would be necessary to elicit a well organized, near effortless functional gait with a walker. Function is defined in terms of accomplishing task-specific activities in the home and community. OBJECTIVES: To demonstrate the feasibility and benefits of combined PWBT and ESCS therapies aimed at promoting functional gait in a wheelchair-dependent ASIA C SCI subject. SETTING: The Clinical Neurobiology and Bioengineering Research Laboratories at Good Samaritan Regional Medical Center, Phoenix, Arizona, USA, and the Department of Bioengineering, Arizona State University, Tempe, Arizona, USA. METHODS: The study began with the application of PWBT. The subject walked on the treadmill until a plateau in gait rhythm generation was reached. Subsequently, ESCS, applied to the lumbar enlargement, was utilized to facilitate PWBT and, later, over-ground walking for a standard distance of 15 m. Gait performance was analyzed by measuring average speed, stepping symmetry, sense of effort, physical work capacity, and whole body metabolic activity. RESULTS: PWBT led to improved stereotypic stepping patterns associated with markedly reduced spasticity, but was insufficient for over-ground walking in terms of safety, energy cost, and fatigue. ESCS with PWBT generated immediate improvement in the subject's gait rhythm when appropriate stimulation parameters were used. When compared to the non-stimulated condition, over-ground walking with ESCS across a 15 m distance was featured by a reduction in time and energy cost of walking, sense of effort, and a feeling of 'lightness' in the legs. After a few months of training, performance in speed, endurance, and metabolic responses gradually converged with/without ESCS at this short distance, suggesting a learned response to these conditions. However, at longer distances (eg, 50-250 m), performance with ESCS was considerably superior. The subject was able to perform multiple functional tasks within the home and community with ESCS. CONCLUSION: We propose that ESCS augments the use-dependent plasticity created by PWBT and may be a valuable adjunct to post-SCI treadmill training in ASIA C subjects. We also conclude that ESCS elicits greater activation of an oxidative motor unit pool, thereby reducing the subject's sense of effort and energetic cost of walking. pubtype: Academic Journal doctype: case study research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|