Orthotic walking outcome of persons with motor complete low thoracic spinal cord injury-a retrospective study.

STUDY DESIGN: Retrospective study. OBJECTIVE: To analyse the orthotic walking outcome of patients with Low Thoracic Spinal Cord Injury (LT-SCI). SETTING: The Rehabilitation Institute at Christian Medical College, Vellore, India. METHODS: Data between January 2005 and June 2015 were retrospectively collected from electronic medical reports of patients with motor complete LT- SCI who were admitted for the comprehensive rehabilitation program. The orthotic walking outcome of these patients was measured by the Walking index for SCI version II (WISCI II). Demographical and clinical parameters were measured and their association with the walking outcome was analyzed using regression analysis. RESULTS: A total of 430 patients were identified within the study period. Eighty-five percent of people (n = 365) achieved walking at the time of discharge (WISCI II level 12 = 260 and level 9 = 105). Out of 11 demographical and clinical parameters considered, eight of them were found to be significant predictors of walking in the univariate analysis. Age less than 30 years had the highest odds of predicting WISCI II level 9 and level 12 than those older in the multivariate analysis (OR 17.58; 95% CI 7.35-42.03). Single neurological level T12 increased the chance of achieving WISCI II level 12 by 10 times (OR 10.2; 95% CI 3.8-27.36). CONCLUSIONS: Orthotic walking for persons with motor complete low thoracic spinal cord injury is an achievable goal through a comprehensive rehabilitation program. The factors identified in this study will help rehabilitation professionals strategically select the ideal candidate for orthotic gait training.

Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial.

OBJECTIVE: To compare the effectiveness of body weight-supported treadmill training and body weight-supported overground training for improving gait and strength in people with traumatic incomplete tetraplegia. DESIGN: Assessor blinded randomized trial. SETTING: Rehabilitation institute of a tertiary care teaching hospital in India. PARTICIPANTS: Sixteen participants with traumatic motor incomplete tetraplegia and within two years of injury. INTERVENTIONS: Participants were randomised to one of two groups: body weight-supported overground training on level ground and body weight-supported treadmill training. Both groups received 30 minutes of gait training per day, five days a week for eight weeks. In addition, both groups received regular rehabilitation which included flexibility, strength, balance, self care and functional training. OUTCOME MEASURES: The primary outcome measure was the Walking Index for Spinal Cord Injury (/20 points) and the secondary outcome was the Lower Extremity Muscle Score (/50 points). RESULTS: There was no statistically significant between group differences in the Walking Index for Spinal Cord Injury [mean difference=0.3points; 95% CI (-4.8 to 5.4); p=0.748] or the Lower Extremity Muscle Score [mean difference=0.2 points; 95% CI (-3.8 to 5.1); p=0.749]. CONCLUSIONS: Gait training with body weight-supported overground training is comparable to treadmill training for improving locomotion in people with traumatic incomplete tetraplegia.

Physiological and Metabolic Responses of Amateur Spinal Cord Injured Wheelchair Racers Participating in a Marathon: A Pilot Observational Study.

OBJECTIVES: We analyzed exercise-related changes in cardiac troponins and other physiological and metabolic parameters in amateur wheelchair racers with spinal cord injury (SCI) participating in a marathon event. METHODS: This pilot, prospective, observational study was conducted at a community marathon event. Fifteen community-living individuals with SCI who had registered to participate in the marathon were recruited for the study. Participants with SCI used manually propelled wheelchairs (n=5) or tricycles (n=10). The outcome measures were high-sensitivity cardiac troponin-T levels (hs-cTnT), heart rate, and metabolic parameters, including body temperature, serum electrolytes, and urine osmolality. These parameters were compared with 15 age- and race-distance-matched non-SCI runners who participated in the same marathon. RESULTS: Participants with SCI had a higher median (inter-quartile range) baseline hs-cTnT level [13.7 ng/L (10.3-25)] than did runners [4.2 ng/L (3.2-8.7; P <0.001)]. Post-race values of hs-cTnT were elevated in participants with SCI [28.0 ng/L (19.0-48.2)] and in runners [41.5 ng/L (18.4-87.1, P= 0.7)]; however, there was no significant difference between the two groups. Other parameters were not significantly different between SCI participants and runners. CONCLUSION: Post-race hs-cTnT levels of amateur SCI participants were elevated but were not significantly different from those of runners. Other race-induced physiological and metabolic changes in SCI participants were comparable to those of runners. The high baseline hs-cTnT levels in participants with SCI observed in this study warrant further research.

Heel lift improves walking ability of persons with traumatic cauda equina syndrome-a pilot experimental study.

STUDY DESIGN: Non-randomized within-subject experimental study. OBJECTIVE: To determine whether the addition of the 1 cm heel lift to the footwear improves the walking ability of the persons with Cauda Equina Syndrome (CES). SETTING: Department of Physical Medicine and Rehabilitation, Christian Medical College, India. METHODS: Fourteen people with bilateral plantar flexor weakness following traumatic CES (mean age 43.7 years) were recruited for the study. Their walking speed, stride length, cadence, and time taken to complete Timed Up and Go (TUG) were measured using footwear with back straps. Then, the 1 cm heel lift was attached to the sole of the footwear. After sufficient practice, all the parameters were reassessed to find out the effectiveness of the heel lift. RESULTS: With the 1 cm heel lift, the participants walked 0.13 m/s (95% CI, 0.08-0.17) faster than their regular footwear. They were able to complete the TUG test 2.6 s (95% CI, 1.4-3.7) earlier than before. There was an increase of 5.2 in. in stride length (95% CI, 2.9-9) and an eight steps increase in cadence (95% CI, 4.9-11.3) observed after the heel lift. CONCLUSIONS: This pilot study has demonstrated that addition of 1 cm heel may be effective in improving the walking performance of persons with Cauda Equina Syndrome. Future studies should investigate the kinetic and kinematic changes of this modification using a randomized controlled trial study design.

Paraplegia and transtibial amputation: successful ambulation after dual disability: a retrospective case report.

INTRODUCTION: This is a single-subject case report. The objective is to describe the unique rehabilitation outcome of an individual with motor complete T12 paraplegia and a right transtibial amputation. This study was conducted at the Department of Physical Medicine and Rehabilitation of Christian Medical College in India. CASE PRESENTATION: A 42-year-old policeman presented to our rehabilitation centre with motor complete T12 paraplegia and right transtibial amputation, 3 months following a road traffic accident. As the patient's goal was to walk, he was given a trial of independent ambulation with a customized prosthesis on the right side and a regular knee ankle foot orthosis (KAFO) on the left side. DISCUSSION: At the end of 12 weeks of rehabilitation, the patient was able to walk independently with the prosthesis/orthosis and bilateral elbow crutches. His Walking Index for Spinal Cord Injury (WISCI) score improved from 0/20 to 12/20 points. The scope of functional ambulation should not get restricted for a person with low thoracic spinal cord injury even when there is concurrent transtibial amputation.