KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
Spinal Cord. 2020 Feb;58(2):185-193. doi: 10.1038/s41393-019-0332-y. Epub 2019 Jul 29.
Cross sectional.
To compare the reactive stepping ability of individuals living with incomplete spinal cord injury or disease (SCI/D) to that of sex- and age-matched able-bodied adults.
A tertiary SCI/D rehabilitation center in Canada.
Thirty-three individuals (20 with incomplete SCI/D) participated. Participants assumed a forward lean position in standing whilst 8-12% of their body weight was supported by a horizontal cable at waist height affixed to a rigid structure. The cable was released unexpectedly, simulating a forward fall and eliciting one or more reactive steps. Behavioral responses (i.e., single step versus non-single step) were compared using a Chi-square test. The following temporal parameters of reactive stepping were compared using t-tests: the onset of muscle activation in 12 lower extremity muscles (six per limb) and step-off, step contact and swing time of the stepping leg.
Behavioral responses were significantly different between groups (χ = 13.9 and p < 0.01) with participants with incomplete SCI/D showing more non-single step responses (i.e., multi-steps and falls). The onsets of muscle activation were more variable in participants with incomplete SCI/D, but only the stepping tibialis anterior showed a significantly slower onset in this group compared with able-bodied adults (t = -2.11 and p = 0.049). Movement timing of the stepping leg (i.e., step-off, step contact, and swing time) was not significantly different between groups.
Reactive stepping ability of individuals with incomplete SCI/D is impaired; however, this impairment is not explained by temporal parameters. The findings suggest that reactive stepping should be targeted in the rehabilitation of ambulatory individuals with SCI/D.
横断面研究。
比较不完全性脊髓损伤或疾病（SCI/D）患者与年龄和性别匹配的健康成年人的反应性跨步能力。
加拿大一家三级 SCI/D 康复中心。
33 名参与者（20 名不完全性 SCI/D 患者）参与了研究。参与者在站立时采取前倾姿势，身体 8-12%的重量由腰部高度固定在刚性结构上的水平电缆支撑。电缆意外释放，模拟向前跌倒，引发一次或多次反应性跨步。使用卡方检验比较行为反应（即单步与非单步）。使用 t 检验比较反应性跨步的以下时间参数：12 个下肢肌肉（每条腿 6 个）的肌肉激活起始时间和跨步腿的步出、步接触和摆动时间。
组间行为反应差异有统计学意义（χ=13.9，p<0.01），不完全性 SCI/D 患者表现出更多的非单步反应（即多步和跌倒）。不完全性 SCI/D 患者的肌肉激活起始时间更具变异性，但只有跨步胫骨前肌的起始时间明显比健康成年人慢（t=-2.11，p=0.049）。跨步腿的运动时间（即步出、步接触和摆动时间）在组间无显著差异。
不完全性 SCI/D 患者的反应性跨步能力受损；然而，这种损伤不能用时间参数来解释。研究结果表明，反应性跨步能力应作为 SCI/D 患者康复的目标。
