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Motor Adaptation to Weight Shifting Assistance Transfers to Overground Walking in People with Spinal Cord Injury
PM&R (2019)
  • Jui-Te Lin, Seton Hall University
  • Chao-Jung Hsu, Shirley Ryan AbilityLab
  • Weena Dee, Shirley Ryan AbilityLab
  • David Chen, Shirley Ryan AbilityLab
  • W. Zev Rymer, Northwestern University
  • Ming Wu, Northwestern University
Abstract
Background
Locomotor training has been used to improve walking function in people with incomplete spinal cord injury (iSCI), but functional gains are relatively small for some patients, which may be due to the lack of weight shifting training.

Objective
To determine whether applying a pelvis assistance force in the coronal plane during walking would improve weight shifting and stepping in people with iSCI.

Design
Repeated measures study.

Setting
Rehabilitation hospital.

Participants
Seventeen people with iSCI.

Interventions
A controlled assistance force was bilaterally applied to the pelvis in the medial-lateral direction to facilitate weight shifting, which gradually increased during the course of treadmill walking.

Main Outcome Measures
Weight shifting, step length, margin of stability, and muscle activities of the weaker leg were used to quantify gait performance. The spatial-temporal gait parameters during overground walking were collected pre, post, and 10 minutes after treadmill training.

Results
During treadmill walking, participants significantly improved weight shifting (ie, center of mass [CoM] lateral distance reduced from 0.16 ± 0.06 m to 0.12 ± 0.07 m, P = .012), and increased step length (from 0.35 ± 0.08 m to 0.37 ± 0.09 m, P = .037) on the stronger side when the force was applied, which were partially retained (ie, CoM distance was 0.14 ± 0.06, P = .019, and step length was 0.37 ± 0.09 m, P = .005) during the late postadaptation period when the force was removed. In addition, weight shifting and step length on the weaker side during overground walking also improved (support base reduced from 0.13 ± 0.06 m to 0.12 ± 0.06 m, P = .042, and step length increased from 0.48 ± 0.12 m to 0.51 ± 0.09 m, P = .045) after treadmill training.

Conclusions
Applying pelvis assistance during treadmill walking may facilitate weight shifting and improve step length in people with SCI, which may partially transfer to overground walking.

Level of Evidence
III.
Publication Date
November, 2019
DOI
10.1002/pmrj.12132
Citation Information
Jui-Te Lin, Chao-Jung Hsu, Weena Dee, David Chen, et al.. "Motor Adaptation to Weight Shifting Assistance Transfers to Overground Walking in People with Spinal Cord Injury" PM&R Vol. 11 Iss. 11 (2019) p. 1200 - 1209 ISSN: 1934-1482
Available at: http://works.bepress.com/jui-te-lin/6/