Walking Adaptability Post-Spinal Cord Injury

Not Applicable

Completed

Interventions: Behavioral: Locomotor Training
Other: Cross-Sectional Testing (No Intervention)

Brief Summary: The purpose of this study is: (1) to establish assessment techniques (in our laboratory) to identify the functional integrity of long spinal tracts associated with adaptive walking recovery post-spinal cord injury and (2) to preliminary investigate locomotor outcomes associated with an adaptive locomotor training approach post-spinal cord injury.

Detailed Description: Eligible individuals without spinal cord injury that are enrolled in the study will participate for 1-2 days. These individuals may undergo a variety of non-invasive neurophysiological tests which evaluate spinal reflexes and integrity of specific spinal pathways. In addition, their movement may be assessed during walking on a treadmill and overground in a variety of different conditions (e.g. with mirrors, without mirrors, with obstacles, without obstacles).

Eligible individuals with spinal cord injury that are enrolled in the study will undergo the same testing as described above for the healthy controls. In addition, a small subset of these individuals may receive locomotor training (3 weeks of basic locomotor training followed by 3 weeks of adaptive locomotor training, separated by a 3 week washout period). For the individuals receiving locomotor training, they will be tested before and after each 3 week training session.

Recruitment & Eligibility

Inclusion Criteria

18 years or older
no neurologic injury (for individuals without SCI)
>12 mos post-incomplete SCI (iSCI), discharged from in- and out-patient rehabilitation, with diagnosis of first time motor iSCI (AIS C or D with upper motor neuron lesions at cervical or thoracic levels) (for individuals with SCI)
medically stable condition with no changes in anti-spasticity meds
ability to walk in the home and/or ambulate in the community using a single cane or crutch, bilateral canes or crutches, or no device
walking speeds > 0.3 m/sec, with deficit performance on the Dynamic Gait Index
medically approved for participation

Exclusion Criteria

current participation in another rehabilitation program/research protocol
history of congenital SCI or other degenerative spinal disorders
inappropriate or unsafe fit of the harness and/or joint contractures or severe spasticity that would prohibit the safe provision of training
receipt of a therapeutic intervention or medication within the last 6 mos that would alter the nervous system's ability to respond to treatment (e.g. Botox injections)
unable to safely receive transcranial magnetic stimulation due to positive history which prohibits its use

Arm && Interventions

Group	Intervention	Description
Basic Locomotor Training	Locomotor Training	Individuals will receive 15sessions of the traditional form of basic locomotor training for 3 weeks. Repetitive stepping patterns are practiced on the treadmill and overground.
Cross-Sectional Testing	Cross-Sectional Testing (No Intervention)	Individuals with and without spinal cord injury will be evaluated to develop protocols within our laboratory to assess reflexes (spinal tract integrity), walking ability, and whether mirror images during walking enhance or disrupt motor responses during walking.
ADAPT Locomotor Training	Locomotor Training	Individuals receive 15 sessions of ADAPT-locomotor training for 3 weeks. During ADAPT-locomotor training, stepping in response to obstacles and walking challenges are practiced on a treadmill and overground.

Primary Outcome Measures

Name	Time	Method
Changes in joint movement (Kinematics)	At approximately 0 weeks (pre-LT#1), 3 weeks (post-LT#1), 6 weeks (pre-LT#2) and 9 weeks (post-LT#2). Times may vary slightly if training sessions are missed (i.e. due to illness).	During walking on the treadmill and overground, movement of lower extremity joints (hip, knee, and ankle) will be quantified using reflective markers and a 3D motion analysis system.

Secondary Outcome Measures

Name	Time	Method
Changes in functional integrity of spinal pathways	At approximately 0 weeks (pre-LT#1), 3 weeks (post-LT#1), 6 weeks (pre-LT#2) and 9 weeks (post-LT#2). Times may vary slightly if training sessions are missed (i.e. due to illness).	Non-invasive protocols will be used to test a variety of reflexes that provide indirect measures related to the integrity of specific spinal pathways.
Changes in falls risks during adaptive walking challenges	At approximately 0 weeks (pre-LT#1), 3 weeks (post-LT#1), 6 weeks (pre-LT#2) and 9 weeks (post-LT#2). Times may vary slightly if training sessions are missed (i.e. due to illness).	Individuals will be tested on a special treadmill that perturbs walking and makes indirect measurements related to falls risks

Locations (4): James A. Haley VA Medical Center
🇺🇸
Tampa, Florida, United States
Brain Rehabilitation Research Center, Malcom Randall VAMC
🇺🇸
Gainesville, Florida, United States
Brooks Rehabilitation
🇺🇸
Jacksonville, Florida, United States
University of Florida
🇺🇸
Gainesville, Florida, United States