Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
Cereneo Foundation, Center for Interdisciplinary Research, 6354, Vitznau, Switzerland.
J Neuroeng Rehabil. 2022 Mar 25;19(1):36. doi: 10.1186/s12984-022-01013-7.
Walking over obstacles requires precise foot placement while maintaining balance control of the center of mass (CoM) and the flexibility to adapt the gait patterns. Most individuals with incomplete spinal cord injury (iSCI) are capable of overground walking on level ground; however, gait stability and adaptation may be compromised. CoM control was investigated during a challenging target walking (TW) task in individuals with iSCI compared to healthy controls. The hypothesis was that individuals with iSCI, when challenged with TW, show a lack of gait pattern adaptability which is reflected by an impaired adaptation of CoM movement compared to healthy controls.
A single-center controlled diagnostic clinical trial with thirteen participants with iSCI (0.3-24 years post injury; one subacute and twelve chronic) and twelve healthy controls was conducted where foot and pelvis kinematics were acquired during two conditions: normal treadmill walking (NW) and visually guided target walking (TW) with handrail support, during which participants stepped onto projected virtual targets synchronized with the moving treadmill surface. Approximated CoM was calculated from pelvis markers and used to calculate CoM trajectory length and mean CoM Euclidean distance TW-NW (primary outcome). Nonparametric statistics, including spearman rank correlations, were performed to evaluate the relationship between clinical parameter, outdoor mobility score, performance, and CoM parameters (secondary outcome).
Healthy controls adapted to TW by decreasing anterior-posterior and vertical CoM trajectory length (p < 0.001), whereas participants with iSCI reduced CoM trajectory length only in the vertical direction (p = 0.002). Mean CoM Euclidean distance TW-NW correlated with participants' neurological level of injury (R = 0.76, p = 0.002) and CoM trajectory length (during TW) correlated with outdoor mobility score (R = - 0.64, p = 0.026).
This study demonstrated that reduction of CoM movement is a common strategy to cope with TW challenge in controls, but it is impaired in individuals with iSCI. In the iSCI group, the ability to cope with gait challenges worsened the more rostral the level of injury. Thus, the TW task could be used as a gait challenge paradigm in ambulatory iSCI individuals. Trial registration Registry number/ ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17.
行走于障碍物上需要精准的脚步放置，同时保持身体重心（CoM）的平衡控制，并具备适应步态模式的灵活性。大多数不完全性脊髓损伤（iSCI）患者能够在平地进行地面行走；然而，步态稳定性和适应性可能会受到影响。本研究旨在比较 iSCI 患者和健康对照组在挑战性目标行走（TW）任务中的 CoM 控制。研究假设 iSCI 患者在面对 TW 任务时，表现出步态模式适应性不足，这反映在 CoM 运动的适应性受损上，与健康对照组相比存在差异。
采用单中心对照性临床诊断试验，纳入 13 名 iSCI 患者（损伤后 0.3-24 年；1 名亚急性，12 名慢性）和 12 名健康对照组。在两种情况下采集参与者的足部和骨盆运动学数据：正常跑步机行走（NW）和视觉引导目标行走（TW），TW 时参与者借助扶手踏上同步移动跑步机表面上的虚拟目标。通过骨盆标记物计算近似 CoM，并计算 CoM 轨迹长度和 TW-NW 时的 CoM 平均欧几里得距离（主要结果）。采用非参数统计，包括 Spearman 秩相关分析，评估临床参数、户外移动评分、表现与 CoM 参数之间的关系（次要结果）。
健康对照组通过减少前后向和垂直 CoM 轨迹长度来适应 TW（p<0.001），而 iSCI 患者仅在垂直方向上减少 CoM 轨迹长度（p=0.002）。TW-NW 时的 CoM 平均欧几里得距离与参与者的神经损伤水平（R=0.76，p=0.002）相关，TW 时的 CoM 轨迹长度与户外移动评分相关（R=-0.64，p=0.026）。
本研究表明，在控制组中，减少 CoM 运动是应对 TW 挑战的常见策略，但在 iSCI 患者中则受到损害。在 iSCI 组中，随着损伤水平的升高，应对步态挑战的能力越差。因此，TW 任务可作为有能力在平地行走的 iSCI 患者的步态挑战范式。
试验注册号/ClinicalTrials.gov 标识符：NCT03343132，登记日期 2017/11/17。
