Andrea Behrman PT PhD
University of Florida
Dr. Asmita Karajgi
Associate Professor
Dept of Physiotherapy
Pad. Dr. D Y Patil University
Nerul, Mumbai
Promising experimental approach
Improves speed
step symmetry
obstacle negotiation
Case description- 4.5 yr old boy
16 weeks post injury(gunshot wound)
low cervical spinal cord injury
3 months of inpatient rehabilitation+10 mth of
outpatient rehabilitation
improved from AIS –A to AIS –C with bilat C 8
‘a lot of extensor tone in quadriceps and no
voluntary hip flexion ,ankle or toe movement’
could not stand independently
prognosis-wheelchair bound
prior to training –
&Plantar flexors-1)
spasticity (quadriceps-2
ASIA impairement
scale(Plantar flexors-2 for each leg)
sessions of locomotor training
20-30 minutes of step training with BWS on treadmill
followed by 10-20 minutes of overground training with
graded sensory cues.
Assistance at the pelvis,trunk and each lower limb
Training 5 times per week –45 sessions—76 sessions
Upright posture &LE weight bearing without upper limb weight
Limb co-ordination with arm swing
Aim of approximating normal walking speed
5 min –bout of step training on treadmill(stretches to hip
flexors and dorsiflexors) followed by bout of stand
training(BWS was reduced,manual pressure to knee and ankle
Transfer to overground training
ASIA –SAME (AIS –C with bilat C 8 function)
Only hip flexors improved from 0 to 1 after 74 sessions
Locomotor recoveryBaseline-nonambulatory
22 sittings-slight activity of ext and improved shoulder
alignment with pelvis
After 6 sessions of intense cueing-active contribution to
Noncued steps
After 18 sessions (51-76)-independent use of posterior
rolling walker
Walking index score from 0 to 13/20 but no change in LEMS
Gait speed 0.29m/s(self selected) &0.48 (maximum )
2488 community based steps.
Recovery only locomotor dependent
2 components –
1 using sensory input by trainers
2 activation of SPGL by the patient
 Cortico brainstem spinal system activation
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