Non-gait-specific intervention for the rehabilitation of walking after SCI: role of the arms.

Arm movements modulate leg activity and improve gait efficiency; however, current rehabilitation interventions focus on improving walking through gait-specific training and do not actively involve the arms. The goal of this project was to assess the effect of a rehabilitation strategy involving simultaneous arm and leg cycling on improving walking after incomplete spinal cord injury (iSCI). We investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in over ground walking capacity. Participants with iSCI were assigned to simultaneous arm-leg cycling (A&L) or legs only cycling (Leg) training paradigms, and cycling movements were assisted with electrical stimulation. Overground walking speed significantly increased by 0.092 ± 0.022 m/s in the Leg group and 0.27 ± 0.072m/s in the A&L group after training. Whereas the increases in the Leg group were similar to those seen after current locomotor training strategies, increases in the A&L group were significantly larger than those in the Leg group. Walking distance also significantly increased by 32.12 ± 8.74 m in the Leg and 91.58 ± 36.24 m in the A&L group. Muscle strength, sensation, and balance improved in both groups; however, the A&L group had significant improvements in most gait measures and had more regulated joint kinematics and muscle activity after training compared with the Leg group. We conclude that electrical stimulation-assisted cycling training can produce significant improvements in walking after SCI. Furthermore, active arm involvement during training can produce greater improvements in walking performance. This strategy may also be effective in people with other neural disorders or diseases. NEW & NOTEWORTHY This work challenges concepts of task-specific training for the rehabilitation of walking and encourages coordinated training of the arms and legs after spinal cord injury. Cycling of the legs produced significant improvements in walking that were similar in magnitude to those reported with gait-specific training. Moreover, active engagement of the arms simultaneously with the legs generated nearly double the improvements obtained by leg training only. The cervico-lumbar networks are critical for the improvement of walking.

Lack of efficacy of music to improve sleep: a polysomnographic and quantitative EEG analysis.

An increasing number of studies have been examining non-pharmacological methods to improve the quality of sleep, including the use of music and other types of auditory stimulation. While many of these studies have found significant results, they suffer from a combination of subjective self-report measures as the primary outcome, a lack of proper controls, often combine music with some type of relaxation therapy, or do not randomise subjects to control and treatment conditions. It is therefore difficult to assess the efficacy of music to induce or improve sleep. The present study therefore examined the effects of music using standard polysomnographic measures and quantitative analysis of the electroencephalogram, along with subjective ratings of sleep quality. In addition, a tones condition was used to compare any effects of music with the effects of general auditory stimulation. Using a counter-balanced within-subjects design, the music was not significantly better than the tones or control conditions in improving sleep onset latency, sleep efficiency, wake time after sleep onset, or percent slow wave sleep, as determined by objective physiological criteria.