The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury
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| Language: | English |
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The Ohio State University / OhioLINK
2010
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=osu1290605215 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu1290605215 |
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oai_dc |
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NDLTD |
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English |
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Rehabilitation incomplete spinal cord injury SCI iSCI locomotor training chronic spinal cord injury walking capacity |
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Rehabilitation incomplete spinal cord injury SCI iSCI locomotor training chronic spinal cord injury walking capacity Buehner, Jeffrey J. The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| author |
Buehner, Jeffrey J. |
| author_facet |
Buehner, Jeffrey J. |
| author_sort |
Buehner, Jeffrey J. |
| title |
The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| title_short |
The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| title_full |
The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| title_fullStr |
The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| title_full_unstemmed |
The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury |
| title_sort |
impact of manual-assisted locomotor training on walking ability and sensory and motor scores in chronic motor incomplete spinal cord injury |
| publisher |
The Ohio State University / OhioLINK |
| publishDate |
2010 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=osu1290605215 |
| work_keys_str_mv |
AT buehnerjeffreyj theimpactofmanualassistedlocomotortrainingonwalkingabilityandsensoryandmotorscoresinchronicmotorincompletespinalcordinjury AT buehnerjeffreyj impactofmanualassistedlocomotortrainingonwalkingabilityandsensoryandmotorscoresinchronicmotorincompletespinalcordinjury |
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1719429468052783104 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu12906052152021-08-03T06:01:01Z The Impact of Manual-assisted Locomotor Training on Walking Ability and Sensory and Motor Scores in Chronic Motor Incomplete Spinal Cord Injury Buehner, Jeffrey J. Rehabilitation incomplete spinal cord injury SCI iSCI locomotor training chronic spinal cord injury walking capacity <p>Spinal Cord Injury (SCI) is a devastating disability that negatively impacts quality of life and the inability to ambulate or ambulate well is considered by many to be the greatest functional limitation. Therefore, development of rehabilitation interventions that maximize locomotor abilities for those with SCI are vital. Manual-assisted Locomotor Training is an activity-based therapy developed to induce locomotor and functional gains in those with neurologic impairment. However, the impact of Locomotor Training on locomotor ability, balance, strength and sensation in chronic motor incomplete SCI is currently unknown.</p><p>This study determined the magnitude and rate of locomotor improvement following Locomotor Training and the amount of Locomotor Training needed to elicit these changes for persons with chronic motor incomplete SCI treated in the multi-site NeuroRecovery Network (NRN). Locomotor performance was measured by gait speed, distance and attainment of functional speeds reported for in-home (<0.44 m/s) or community ambulation (0.44 m/s). In addition, we determined the impact of Locomotor Training on American Spinal Injury Association (ASIA) exam sensory and motor scores for lower extremity strength and sensation. The relationship between sensory and motor scores and recovery of locomotion and balance after Locomotor Training was examined. Lastly, we determined the degree of agreement in final gait speeds obtained for short bout locomotion during the 10 meter walk test (10MWT) and for long bout locomotion during the 6 minute walk test (6MWT).</p><p>Using a prospective, cohort design, we compared sensory and motor scores and functional outcomes pre and post-intervention for individuals that had completed Locomotor Training in the NRN from March 2005 to July 2010. Participants included225 individuals with chronic motor incomplete SCI with ASIA Impairment Scale of C or D (mean 2.45±3.79 years post-injury). The NRN Locomotor Training intervention consisted of manual-assisted body-weight supported treadmill step training, over ground assessment and community reintegration for about 1.5 hrs per session. Training occurred 3-5 times a week for an average of 60 sessions over an average of 5 months.</p><p>Outcome measures collected before and after the intervention included: AIS classification; lower extremity and upper extremity motor scores (LEMS, UEMS); lower extremity pin prick scores; lower extremity light touch scores; gait speeds for the 10MWT and the 6MWT; gait distances for the 6MWT; and, balance using the Berg Balance Scale (BBS). Comparisons were made for the overall sample, AIS C and D subsets, paraplegia/tetraplegia subsets and functional gait speed stratifications.</p><p>No significant changes in sensory or motor scores were found following Locomotor Training except LEMS (pre: 31.85±13.98; post: 38.61±12.29; p<0.05) and UEMS (pre: 38.36±10.83; post: 41.44±8.27; p<0.05). Significant gains in gait speed (pre: 0.32±0.40 m/s; post: 0.55±0.55 m/s; p<0.05), gait distance (pre: 94.4±115.09 m; post: 164.42±159.82 m; p<0.05), and balance (BBS pre: 20.48±17.70; post: 29.24±20.60; p<0.05) were found. While significant correlations occurred, no relationship was found for AIS C and D subsets between sensory and motor scores and gait speed (r2= 0.026-0.070; r2= 0.051-0.241 respectively), distance (r2= 0.011-0.097; r2=0.037-0.251 respectively) or balance (r2= 0.109-0.177; r2=0.072-0.333 respectively) following Locomotor Training. A significant (p<0.05) moderate positive relationship between initial LEMS and final Berg Balance Scores occurred for paraplegia and tetraplegia subsets (r2=0.497 and 0.478 respectively). Conversion between functional gait speed stratifications occurred following Locomotor Training with 47% of the sample ambulating at community gait speeds at discharge (0.44 m/s). Sixty-four percent of the sample achieved peak gait speed at discharge. Final speeds obtained from the 10MWT for the overall sample were 17% higher than speeds obtained from the 6MWT. However, 20% produced higher gait speeds during long bout 6MWT ambulation compared with short bout 10MWT ambulation at discharge.</p><p>Manual-assisted Locomotor Training improves gait speed, distance, balance and functional ambulation ability in individuals with chronic motor incomplete SCI. The ASIA exam sensory and motor scores and AIS classification appear to be poor indicators of recovery of walking and care should be taken when using them to determine treatment efficacy or functional improvement. Functional classification based on gait speed during short bout ambulation may be a more sensitive indicator of meaningful locomotor recovery. That 16% of subjects at enrollment produced faster speeds during long bout locomotion suggests that even these classifications may underreport recovery. Whether speeds derived from the 6MWT align more closely with community ambulation ability than the 10MWT should be examined. It seems likely that each test describes different domains of walking ability in those with chronic incomplete SCI following Locomotor Training. Finally, different functional severities may require different doses of Locomotor Training to maximize locomotor abilities. These results will help determine allocation of resources to maximize locomotor outcomes as efficiently and effectively as possible in people with chronic SCI.</p> 2010-12-16 English text The Ohio State University / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=osu1290605215 http://rave.ohiolink.edu/etdc/view?acc_num=osu1290605215 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |