Citation

Spiess MR, Jaramillo JP, Behrman AL, Teraoka JK, Patten C. Arch. Phys. Med. Rehabil. 2012; 93(8): 1476-1484.

Affiliation

Brain Rehabilitation Research Center of Excellence - Malcolm Randall VA Medical Center, Gainesville, FL; Department of Physical Therapy, University of Florida, Gainesville, FL.

Copyright

(Copyright © 2012, Elsevier Publishing)

DOI

10.1016/j.apmr.2012.02.030

PMID

22446153

Abstract

OBJECTIVE: To investigate the effect of walking speed on the emergence of locomotor EMG patterns in an individual with chronic incomplete spinal cord injury (SCI) and determine whether central pattern generator activity during robotic locomotor training (RLT) transfers to volitional EMG activity during overground walking. DESIGN: Single case (BAB) design. SETTING: Freestanding rehabilitation research center. PARTICIPANT: The participant was a 50 year old man, non-ambulatory 16 months following incomplete SCI (sub-T11). INTERVENTIONS: The participant completed two 6-week blocks of RLT, training 4 times per week for 30 minutes per session at walking speeds up to 5 km/h (1.4 m/s) over continuous bouts lasting up to 17 minutes. MAIN OUTCOME MEASURES: Surface EMG was recorded weekly during RLT. Overground walking, clinical measures of stepping/walking, including the Walking Index for Spinal Cord Injury (WISCI), were assessed daily during training blocks. RESULTS: During Week 4, reciprocal, patterned EMG emerged during RLT. EMG amplitude modulation revealed a curvilinear relationship over the range of walking speeds from 1.5 to 5 km/h (1.4 m/s). Functionally, the participant improved from being non-ambulatory (WISCI-1), to walking overground with reciprocal stepping using KAFO's and a walker (WISCI-9). EMG was also observed during overground walking. These functional gains were maintained >4 years after LT. CONCLUSION: Here we report an unexpected course of locomotor recovery in an individual with chronic incomplete SCI. Through RLT at physiological walking speeds it was possible to activate the central pattern generator even 16 months post-injury. Further, to a certain degree, improvements from RLT transferred to overground walking. Our results suggest that LT-induced changes affect the central pattern generator and allow supraspinal inputs to engage residual spinal pathways.

Language: en