Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury

Kristan A Leech, Catherine R Kinnaird, Carey L Holleran, Jennifer Kahn, T George Hornby, Kristan A Leech, Catherine R Kinnaird, Carey L Holleran, Jennifer Kahn, T George Hornby

Abstract

Background: High-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.

Objective: The purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.

Design: A single-day, repeated-measures, pretraining-posttraining study design was used.

Methods: Nineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.

Results: The results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.

Limitations: Measures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.

Conclusions: High-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.

© 2016 American Physical Therapy Association.

Figures

Figure 1.
Figure 1.
Assessment of hip-knee average coefficient of correspondence (ACC) values with short-term increases in locomotor exercise intensity (A) and before and after high-intensity training at fastest speeds (B) and fastest-matched speeds (C). Short-term increases in locomotor exercise intensity resulted in increases in hip-knee ACC (A). High-intensity training led to nearly significant and nonsignificant increases in hip-knee ACC at fastest speeds (B) and fastest-matched speeds (C), respectively. *P<.01.
Figure 2.
Figure 2.
Muscle activity and Spastic Locomotor Disorder Index (SLDI) in specific lower extremity muscles at different levels of exercise intensity. Increases in locomotor exercise intensity led to significant increases in measures of overall muscle activity (plotted in gray) in each of the tested muscles (n=16). Most tested muscles demonstrated a nonsignificant trend for decreased SLDI (plotted in black) with increases in exercise intensity (n=16). Exceptions include the rectus femoris muscle, in which the SLDI significantly decreased, and the tibialis anterior muscle, which nonsignificantly increased at higher levels of intensity. *P<.01. EMG=electromyography.

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