1. No category

The role of arms in the rehabilitation of walking
- preliminary results
a
L Alvarado ,
b
Chong ,
a,b
Mushahwar a
Ogilvie ,
SL
R
Vivian K.
a
Centre for Neuroscience, University of Alberta ,
b
and Division of Physical Rehabilitation & Medicine, University of Alberta Assessments
Introduc3on func<onal electrical s<mula<on (FES)-­‐assisted arm + leg cycling • Walking speed (10-­‐meter walking) • Walking endurance (6-­‐minute walking) • Walking consistency R Knee angle (degree)
Results u 10-­‐meter Walking Speed 50% 40% 'leg cycling' Email: 20% 10% 180
160
140
120
140
(pre) r=0.45
(post)r=0.60
(intact)r=0.79
160
180
200
R Hip angle (degree)
220
0 3 6 9 -3
12 Training <me (weeks) 2
MEP pk-pk
u 6-­‐minute Walking Distance 1.5
1
Subject 8 TA MEP recruitment curve
Pre-training
Posttraining
0.5
40% Change in walking distance (%) 220
2.5 x 10
FES-arm + leg cycling appears to produce
larger improvements in walking speed
0
20
30
40
30% 50
60
70
Stim intensity (%)
80
90
Maximum MEP
20% 10% MEPmax (mV) 1.8 1.3 0% •  1 hr/day, 5 days/week, for 12 weeks •  FES on the quadriceps, gluteus maximus, hamstring muscles; FES on arm muscles when needed •  Cycling resistance was increased as the training advanced 160
180
200
R Hip angle (degree)
u Cor<cospinal pathway strength -­‐20% FES-­‐
assisted leg cycling 120
140
(pre) r=0.46
(post)r=0.50
(intact)r=0.78
0% -­‐10% 140
u media player (A video is played here to show the changes in walking before and aHer training) 'arm+leg cycling' 30% 160
Subject 10 – ‘Leg cycling’
• Cor3cospinal pathway strength -­‐Motor Evoked Poten3al(MEP) 60% 180
-­‐10% 0 3 6 9 Training <me(weeks) 12 30% Both FES-arm + leg cycling and FES-leg cycling appear
to produce similar improvements in walking distance
-­‐0.2 10% Pretraining
Posttraining
24 ±43 91 ±116 0.11 ±0.23 Arm+Leg cycling 0.18 175.48 0.49 ±0.1 ±0.03 ±27.93 >1yrs 44 ±71 42.85 ±6.03 (n=5) Conclusion •  Walking speed, distance, consistency and cor3cospinal pathway strength were greatly improved a8er both trainings. •  FES Arm+Leg training showed a trend towards beAer improvements than Leg training in most assessment measures. •  Improvements in walking speed and distance appear to be comparable or even beAer than conven3onal rehabilita3on. •  FES-­‐cycling is physically less demanding on therapists and therefore can benefit more clients.
Acknowledgements 20% 0.3 0.31 ±0.41 0.09±0.1
4 improvements in individuals with chronic incomplete spinal cord injury using locomotor training-­‐based rehabilita3on. Archives of Physical Medicine and Rehabilita6on, vol. 93, 1508-­‐1517. 40% 0.8 Chronic iSCI >3yrs (n=52) Chronic iSCI 1-­‐3 yrs (n=43) References: [1] Harkema et al. (2012). Balance and ambula3on 50% Arm + Leg
Leg
Change Pre-­‐test Change Pre-­‐test in distanc
in walking walking e distance Source speed speed walked walked (m/s) (m/s) (m) (m) normalized change in MEPmax Objec3ve Subject 3 - ‘Arm + Leg cycling’
pre-training
post-training
intact
3 weeks 6 weeks 9 weeks 12 weeks Change in walking speed (%) The overall goal of this study is to improve walking for people with neural disorders, such as incomplete spinal cord injury (iSCI). Walking is a complex task that involves the coordina3on of the arms and legs. Various rehabilita3on techniques are used to improve walking a8er iSCI, but most have focused on the legs without involving the arms. Our lab is ac3vely engaging the arms in a training paradigm u3lizing simultaneous arm and leg cycling in people with iSCI, and has achieved posi3ve func3onal improvements. Email:
[email protected]
Comparing with conven1onal training[1]: u Walking Consistency R Knee angle (degree)
R
a
Zhou ,
0% Arm+Leg Leg FES-arm + leg cycling appears to produce larger
corticospinal connectivity