SCI Optimizing Walking Function Flashcards
Positive prognostic factors for recovery of walking
- AIS D injury
- less time since injury
- age <50
- preservation of pin prick sensation
- Higher LE motor Scores
Negative prognostic factors for recovery of walking
- AIS A
- Age >50
- Cord edema extending multiple levels on MRI
- more time since injury
walking recovery after SCI percentages
1. AIS A
2. AIS B
3. AIS C
4. AIS D
AIS A 14% recover some walkin
AIS B 33% recover some walking
AIS C 75% recover some walking
AIS D 100% recover some waling
Extrinsic factors impacting recovery
- motor learning
- motor relearning
- electrical stimulation
- pharmacology
With repetitive presentation of specific sensory information the spinal cord can ______ sensory information and can adapt in a task specific manner
integrate
What can we influence
locomotor CPG
Neuroplastic principles
Compensatory strategies
Improvement in walking speed and distance in acute onset CNS injury only at _____ intensities and with______ feedback
high intensities with external feedback
Why is locomotor CPG important
- 50% of patients with incomplete SCI or CVA walk
- walking is a patients priority goal
- walking correlates with falling, survival rate
Clinicians should perform in terms of locomotor training
- walking training at mod- high intensities
- walking training coupled with virtual reality
Clinicians may consider to promote walking
- strength training >70% 1 RM
- circuit training, cycling, recumbent stepping
- balance training with virtual reality
Clinicians should not do this to promote walking
- static or dynamic balance activities including pre-gait
- body-weight supported treadmill training with emphasis on kinematics
- robot assisted gait training
training can induce dendritic growth and synapses with specific brain regions that enhance task performance
use it and improve it
the nature of training dictates the nature of the plasticity
specificity
repetition is required to induce lasting neural changes
repetition matters
a sufficient intensity of stimulation is required to induce plasticity
intensity matters
what is high intensity
60-80% of HRR
>15/20 on borg scale
stepping faster increases muscle activity and _____ locomotor patterns
improves
weight bearing _____ muscle activity and _____ locomotor patterns
increases and improves
bear weight through legs during transfers
encourage to stand often as possible
lower body weight support
maximize weight bearing on the legs
generate sensory information essential for driving neural recovery
focus on upright posture, head, trunk, pelvis and legs
quality practice in addition to quantity
optimize kinematics for each motor task
always promoting independence before providing assistance in every motor taks
least restrictive device should be selected when needed for independence, endurance, safety
mimimize compensatory strategies
neuronal and cognitive plasticity depend on continual supply of
BDNF
Factors that should be considered when prescribing an orthotic
sufficient ROM
Physical and cognitive ability and desire to meet ambulation goals
adequate cardiovascular endurance and UE strength indicated for gait activity
KAFO considerations
primary thoracic level
need to have hip extension
Research suggests that providing pt in conjunction with using properly fitting _____ appears to confer the same gait and balance benefit as training with and electrical stimulation orthotic device
AFO
FES cycling indications
reduce muscle atrophy
reduce muscle spasm
improve circulation
maintain increased range of motion
facilitate muscle re-education
WPS allows for _____ of sensory and motor neurons
recruitment
