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Locomotor Training Restores Walking in Non-ambulatory Child with Severe Cervical Spinal Cord Injury

This case study explores the effectiveness of locomotor training in improving walking ability in a non-ambulatory child with chronic, severe incomplete cervical spinal cord injury. The results show promising outcomes in terms of speed, endurance, step symmetry, and obstacle negotiation. The training involved a combination of treadmill and overground training with graded sensory cues. The child showed significant improvement in AIS classification, hip flexors function, and walking index score.

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Locomotor Training Restores Walking in Non-ambulatory Child with Severe Cervical Spinal Cord Injury

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  1. Locomotor training restores walking in a non ambulatuory child with chronic,severe,incomplete cervical spinal cord injury Andrea Behrman PT PhD University of Florida Dr. Asmita Karajgi Associate Professor Dept of Physiotherapy Pad. Dr. D Y Patil University Nerul, Mumbai

  2. Locomotor training • Promising experimental approach • Improves speed endurance step symmetry obstacle negotiation

  3. A single case study-pretest-posttest design • Case description- 4.5 yr old boy 16 weeks post injury(gunshot wound) low cervical spinal cord injury 3 months of inpatient rehabilitation+10 mth of outpatient rehabilitation improved from AIS –A to AIS –C with bilat C 8 function ‘a lot of extensor tone in quadriceps and no voluntary hip flexion ,ankle or toe movement’ could not stand independently prognosis-wheelchair bound

  4. Assessment prior to training – ROM spasticity (quadriceps-2 &Plantar flexors-1) ASIA impairement scale(Plantar flexors-2 for each leg)

  5. Methodology • 76 sessions of locomotor training • 20-30 minutes of step training with BWS on treadmill followed by 10-20 minutes of overground training with graded sensory cues. • Assistance at the pelvis,trunk and each lower limb • Training 5 times per week –45 sessions—76 sessions

  6. Locomotor training Upright posture &LE weight bearing without upper limb weight bearing Limb co-ordination with arm swing Aim of approximating normal walking speed • 5 min –bout of step training on treadmill(stretches to hip flexors and dorsiflexors) followed by bout of stand training(BWS was reduced,manual pressure to knee and ankle extensors) • Transfer to overground training

  7. Results • ASIA –SAME (AIS –C with bilat C 8 function) • Only hip flexors improved from 0 to 1 after 74 sessions • Locomotor recovery- • Baseline-nonambulatory • 22 sittings-slight activity of ext and improved shoulder alignment with pelvis • After 6 sessions of intense cueing-active contribution to stepping • Noncued steps • After 18 sessions (51-76)-independent use of posterior rolling walker

  8. Results • Walking index score from 0 to 13/20 but no change in LEMS • Gait speed 0.29m/s(self selected) &0.48 (maximum ) • 2488 community based steps. • Recovery only locomotor dependent

  9. Discussion • SPGL- • 2 components – 1 using sensory input by trainers 2 activation of SPGL by the patient • Cortico brainstem spinal system activation

  10. THANK YOU

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