Spinal Cord Injury
Conditions
Brief summary
This project will characterize lower extremity eccentric muscle function among individuals who have undergone locomotor training after spinal cord injury and will evaluate the effect of downhill training at slow to moderate speeds - targeted to rehabilitation eccentric function of the hip and knee.
Detailed description
Lower extremity eccentric motor control is is critically important for locomotor function but is impaired after spinal cord injury (SCI). Even after treadmill training, preliminary evidence indicates that eccentric deficits persist among individuals with SCI. This proposal aims to characterize eccentric motor control of the muscles about the hip and knee during locomotion and evaluate the efficacy of downhill gait training at slow speeds as an intervention to improve eccentric function of the hip joint and knee joint during walking.
Interventions
BEHAVIORALUntrained and Trained SCI Hip or Knee
Individuals with SCI will perform downhill walking training 3 times a week for 12 wks with a 4 wk follow-up period. This intervention will be delivered by trained therapists. In order to focus on rehabilitation of hip control or knee control, members of this group will be trained at slow to moderate gait speeds,
Sponsors
University of Notre Dame
Ohio State University
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
Individuals with SCI: Inclusion Criteria: * medically approved * discharged from outpatient rehabilitation for 6 months * incomplete SCI based on ASIA impairment score (AIS C or D) at neurologic level C1-T10 * ability to take some steps overground and on the treadmill * 18-90 years old. * ability to speak English. Note: the quality of life measures have not been validated yet in non-English speaking populations.
Exclusion criteria
* evidence of lower motor neuron injury in the legs * use of botox in the past 3 months * pre-existing or confounding neurologic conditions (i.e. brain injury, stroke, HIV) * acute deep vein thrombosis * skin wounds in regions where harness or hands provide support * pregnancy. Note: Persons who are pregnant will not be enrolled as exercise tolerance is unknown in these women with SCI. * cognitive conditions that preclude providing informed consent * ventilator-dependence as study results will be confounded by mobility limitations imposed by equipment * persistent orthostatic hypotension (drop of BP \>30mmHg in treadmill and harness equipment) * hospitalization for myocardial infarction, cardiac surgery or congestive heart failure exacerbation within 3 months of enrollment in study * participation in any other concurrent exercise programs. Note: Use of anti-spasticity and other medications (dose, frequency) will be monitored throughout training and used as a confounding variable in the analyses.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change from baseline in time to complete 6 minutes of level walking (i.e., the 6 minute walk test) | baseline, 12 weeks |
Secondary
| Measure | Time frame |
|---|---|
| Change from baseline in time to complete 10 meters of level walking (i.e., the 10 meter walk test) | baseline, 12 weeks |
| Change from baseline in peak magnitude of frontal hip loading response as measured by the peak magnitude of frontal hip power absorption during the weight acceptance phase of walking | baseline, 12 weeks |
Other
| Measure | Time frame |
|---|---|
| Change from second baseline in time to complete 6 minutes of level walking (i.e., the 6 minute walk test) | 12 weeks, 16 weeks |
| Change from second baseline in time to complete 10 meters of level walking (i.e., the 10 meter walk test) | 12 weeks, 16 weeks |
| Change from second baseline in peak magnitude of frontal hip loading response as measured by the peak magnitude of frontal hip power absorption during the weight acceptance phase of walking | 12 weeks, 16 weeks |
| Change from baseline in Neuromuscular Recovery Scale score | baseline, 12 weeks |
| Change from second baseline in Neuromuscular Recovery Scale score | 12 weeks, 16 weeks |
| Change from second baseline in balance function as measured by Berg Balance Scale score | 12 weeks, 16 weeks |
| Change from second baseline in SCI specific Quality of Life score | 12 weeks, 16 weeks |
| Change from second baseline in quadriceps eccentric contraction capacity as measured by difference in maximum voluntary eccentric knee flexion contraction before and after eccentric exercise targeting the contralateral quadriceps | 12 weeks, 16 weeks |
| Change from baseline in balance function as measured by the Berg Balance Scale score | baseline, 12 weeks |
| Change from Baseline in SCI specific Quality of Life score | baseline, 12 weeks |
Countries
United States
Outcome results
None listed