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  4. Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics

Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics

JOURNAL OF NEUROTRAUMA, 2017 · DOI: 10.1089/neu.2016.4516 · Published: May 1, 2017

Spinal Cord InjuryNeurologyRehabilitation

Simple Explanation

This study investigates how training affects the ability of individuals with complete spinal cord injuries to stand. It looks at the impact of both stand training and step training when combined with epidural stimulation. The research found that stand training improved standing ability, but subsequent step training impaired it. The type of muscle activity also changed with the different training types. The use of epidural stimulation was necessary for these changes, as training alone did not improve standing ability without it.

Study Duration
Not specified
Participants
Four individuals with chronic paraplegia (two AIS A and two AIS B)
Evidence Level
Level IV; Case Series

Key Findings

  • 1
    Stand training with epidural stimulation improved standing ability in individuals with chronic complete paralysis.
  • 2
    Step training after stand training impaired the previously gained standing ability in most participants.
  • 3
    The type of training influenced the electromyography (EMG) patterns, with improved standing coinciding with continuous EMG activity.

Research Summary

The study examined the effects of stand and step training, combined with epidural stimulation, on standing ability in four individuals with chronic complete paraplegia. Stand training improved standing, whereas subsequent step training impaired it. Improved standing ability correlated with continuous EMG patterns and constant ground reaction forces, while poorer standing was associated with variable EMG patterns. The training protocols did not improve standing ability without epidural stimulation, suggesting the necessity of stimulation for motor function improvement.

Practical Implications

Rehabilitation Strategies

Task-specific training protocols should be carefully designed to avoid regression in specific motor functions such as standing when incorporating locomotor training.

Epidural Stimulation Optimization

Refining epidural stimulation parameters is crucial for maximizing motor function recovery in individuals with spinal cord injuries.

Understanding Motor Learning

Further research is needed to understand how different types of training impact spinal circuitry and motor learning in paraplegic individuals.

Study Limitations

  • 1
    Small sample size (four participants)
  • 2
    Lack of a control group without epidural stimulation
  • 3
    Individual variability in response to training and stimulation

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