Compensation vs Recovery

Question 1

Walking recovery is related to…

Answer 1

Severity of injury (ability to produce voluntary movements below level of lesion)
Rate of recovery
Age
AIS classification

Question 2

How can walking be trained in the absence of supraspinal input

Answer 2

Sensory input associated with locomotion provided to the neural axis and circuitry that generates stepping response

Question 3

Critical elements for retaining walking

Answer 3

Intense practice and repetition
Task specific
Experience/Activity-dependent plasticity

Question 4

What is critical for patients who cannot step

Answer 4

Speed (“sweet spot”)
Loaded LEs with hip extension
Arm swing

Question 5

Activity-based therapies

Answer 5

Emphasis on task specificity and avoiding compensatory movements
Drives neuroplasticity
Ex: locomotor training with a treadmill and overground

Question 6

Why is stepping variability important

Answer 6

Problem solving!

Question 7

Outcome measurement for SCI recovery

Answer 7

NRS - Neuromuscular recovery scale

Reference: movement patterns one day prior to injury

14 functional tasks
4 on treadmill, 14 overground

Question 8

NRS approach

Answer 8

“Top-down” segmental approach
Trunk to pelvis to LE

Four phases

Question 9

Who can benefit from activity based therapy

Answer 9

Patients with an motor-incomplete AIS C-D