locomotor_training_restores_walking_in_a_non_ambulatuory

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Andrea Behrman PT PhD
University of Florida
Dr. Asmita Karajgi
Associate Professor
Dept of Physiotherapy
Pad. Dr. D Y Patil University
Nerul, Mumbai
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Promising experimental approach
Improves speed
endurance
step symmetry
obstacle negotiation
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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
function
‘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)
ROM
spasticity (quadriceps-2
ASIA impairement
scale(Plantar flexors-2 for each leg)
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76
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.
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Assistance at the pelvis,trunk and each lower limb
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Training 5 times per week –45 sessions—76 sessions
Upright posture &LE weight bearing without upper limb weight
bearing
Limb co-ordination with arm swing
Aim of approximating normal walking speed
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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
extensors)
Transfer to overground training
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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
stepping
Noncued steps
After 18 sessions (51-76)-independent use of posterior
rolling walker
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Walking index score from 0 to 13/20 but no change in LEMS
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Gait speed 0.29m/s(self selected) &0.48 (maximum )
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2488 community based steps.
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Recovery only locomotor dependent
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SPGL-
2 components –
1 using sensory input by trainers
2 activation of SPGL by the patient
 Cortico brainstem spinal system activation
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