Article

Clinical trials in spinal cord injury (SCI) primarily rely on
simplified outcome metrics (ie, speed, distance) to obtain a global surrogate for
the complex alterations of gait control. However, these assessments lack
sufficient sensitivity to identify specific patterns of underlying impairment and
to target more specific treatment interventions.
Objective - To disentangle the
differential control of gait patterns following SCI beyond measures of time and
distance. Methods - The gait of 22 individuals with motor-incomplete SCI and 21
healthy controls was assessed using a high-resolution 3-dimensional motion
tracking system and complemented by clinical and electrophysiological evaluations
applying unbiased multivariate analysis. Results Motor-incomplete SCI patients
showed varying degrees of spinal cord integrity (spinal conductivity) with severe
limitations in walking speed and altered gait patterns. Principal component (PC)
analysis applied on all the collected data uncovered robust coherence between
parameters related to walking speed, distortion of intralimb coordination, and
spinal cord integrity, explaining 45% of outcome variance (PC 1). Distinct from
the first PC, the modulation of gait-cycle variables (step length, gait-cycle
phases, cadence; PC 2) remained normal with respect to regained walking speed,
whereas hip and knee ranges of motion were distinctly altered with respect to
walking speed (PC 3). Conclusions -
In motor-incomplete SCI, distinct clusters of
discretely controlled gait parameters can be discerned that refine the evaluation
of gait impairment beyond outcomes of walking speed and distance. These findings
are specifically different from that in other neurological disorders (stroke, Parkinson) and are more discrete at targeting and disentangling the complex
effects of interventions to improve walking outcome following motor-incomplete SCI.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS