Assessment of Dorsiﬂexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation

Bioengineering, 2023 · DOI: https://doi.org/10.3390/bioengineering10050528 · Published: April 26, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study investigates the impact of combining locomotor training (LT) and transcutaneous spinal stimulation (TSS) on ankle movement in people with spinal cord injury (SCI). The research focuses on dorsiflexion, which is the ability to lift the foot, during walking and isolated movements. Participants with subacute motor-incomplete SCI received two weeks of LT alone, followed by two weeks of either LT with TSS or LT with a sham stimulation. The study then assessed ankle movement, muscle activity, and spasticity. The results showed that adding TSS to LT did not significantly improve dorsiflexion ability compared to LT alone. However, locomotor training alone was associated with increased dorsiflexion across tasks.

Study Duration

4 weeks

Participants

10 participants with subacute motor-incomplete SCI

Evidence Level

Not specified

Key Findings

1
Combined LT + TSS did not show persistent effects on dorsiﬂexion ability in people with SCI.
2
Four weeks of locomotor training was associated with increased dorsiﬂexion across tasks.
3
There was a strong positive correlation between the dorsiﬂexor ability for both tasks.

Research Summary

This study aimed to determine whether LT combined with TSS has a persistent effect on dorsiflexion during walking and dorsiflexor AROM in persons with subacute motor-incomplete SCI beyond that observed with LT alone. The study found that training with combined LT and TSS did not have a persistent impact on dorsiﬂexion during the swing phase beyond that observed for LT. After 4 weeks of locomotor training, improvements were observed in all outcome measures, supporting the relationship between dorsiﬂexion during walking and volitional isolated dorsiﬂexion.

Practical Implications

Rehabilitation Strategies

Locomotor training can improve dorsiflexion ability in individuals with SCI.

Further Research

Future studies should explore other factors contributing to improved walking outcomes with TSS, beyond dorsiflexion.

Clinical Practice

Clinicians should consider the potential benefits of locomotor training for enhancing ankle control in SCI patients.

Study Limitations

1
The number of participants who were able to walk without the use of ankle orthotics was small, resulting in a small sample size.
2
Participants’ ability to volitionally activate the dorsiﬂexors may have not been fully captured as the supine position with knees extended requires the participant to overcome tension in the gastrocnemius.
3
this position may facilitate an extensor response in persons with spasticity.

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