Functional community ambulation requirements in incomplete spinal cord injured subjects

Study design: A group of people with incomplete spinal cord injuries (SCI) were evaluated and compared with able-bodied individuals during several walking conditions.Objectives: To evaluate the functional community ambulation and estimated energy expenditure in persons with incomplete SCI and able-bodied individuals.Methods: A list of criteria was used to evaluate functional community ambulation among participants. Physiological variables, such as the heart rate, oxygen uptake and the lactate concentration, were also measured.Results: Three of nine incomplete SCI subjects and all able-bodied subjects were able to meet all the criteria measured. The required velocity to safely cross an intersection was the criterion that the incomplete SCI group had the most difficulty reaching. The able-bodied subjects had a comfortable walking velocity twice that of the incomplete SCI subjects' preferred velocity. When walking at the same velocity (incomplete SCI subjects' preferred velocity), the incomplete SCI subjects had a rate of oxygen uptake 26% greater than the healthy subjects and were 200% less efficient. The lactate concentration also proved to be a useful tool when evaluating the incomplete SCI subjects' walking efficiency. The incomplete SCI subjects lactate concentration increased after walking at their preferred velocity, meaning that the anaerobic pathways were used to meet energy demands.Conclusion: Rehabilitation centers should adapt their evaluation forms and increase their criteria requirements to more suitable criteria that are found in the SCI patient's community. The physiological cost should also be taken into consideration when evaluating the SCI patient's functional ambulation.Spinal Cord (2001) 39, 327–335.

[1]  R J Jaeger,et al.  Rehabilitation Technology for Standing and Walking after Spinal Cord Injury , 1989, American journal of physical medicine & rehabilitation.

[2]  Nene Av,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990 .

[3]  Subbarao Jv.  Walking after spinal cord injury. Goal or wish , 1991 .

[4]  J L Merritt,et al.  Energy expenditure of paraplegic patients standing and walking with two knee-ankle-foot orthoses. , 1984, Archives of physical medicine and rehabilitation.

[5]  S. Rossignol,et al.  Enhancement of locomotor recovery following spinal cord injury. , 1994, Current opinion in neurology.

[6]  R. Waters,et al.  Energy cost of paraplegic locomotion. , 1985, The Journal of bone and joint surgery. American volume.

[7]  J F Sallis,et al.  Compendium of physical activities: classification of energy costs of human physical activities. , 1993, Medicine and science in sports and exercise.

[8]  J W GERSTEN,et al.  ENERGY COST OF AMBULATION IN THE TRAUMATIC PARAPLEGIC , 1964, American journal of physical medicine.

[9]  M. Dimitrijevic,et al.  CORRELATION OF MOTOR CONTROL IN THE SUPINE POSITION AND ASSISTIVE DEVICE USED FOR AMBULATION IN CHRONIC INCOMPLETE SPINAL CORD-INJURED PERSONS , 1994, American journal of physical medicine & rehabilitation.

[10]  C. Robinett,et al.  Functional ambulation velocity and distance requirements in rural and urban communities. A clinical report. , 1988, Physical therapy.

[11]  C. Irvin,et al.  Exercise Physiology , 2003, Springer New York.

[12]  R. Waters,et al.  International Standards for Neurological and Functional Classification of Spinal Cord Injury , 1997, Spinal Cord.

[13]  W. Donovan,et al.  The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury , 1994, Paraplegia.

[14]  Mb Lerner-Frankiel.  Functional community ambulation : what are your criteria? , 1990 .

[15]  A Chantraine,et al.  Energy expenditure of ambulation in paraplegics: effects of long term use of bracing , 1984, Paraplegia.

[16]  Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses. , 1985, Mayo Clinic proceedings.

[17]  R. Waters,et al.  Energy‐speed relationship of walking: Standard tables , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  A V Nene,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990, Archives of physical medicine and rehabilitation.

[19]  P. Bessou,et al.  Simultaneous recording of longitudinal displacements of both feet during human walking. , 1988, Journal de physiologie.

[20]  Orthotics for spinal cord injuries. , 1974 .

[21]  G Barnes,et al.  Determinants of gait performance following spinal cord injury. , 1989, Archives of physical medicine and rehabilitation.

[22]  J. Subbarao,et al.  Walking after spinal cord injury. Goal or wish? , 1991, The Western journal of medicine.

[23]  L. Rubenstein,et al.  Are Older Pedestrians Allowed Enough Time to Cross Intersections Safely? , 1994, Journal of the American Geriatrics Society.

[24]  Cao,et al.  Effects of age, available response time and gender on ability to stop suddenly when walking. , 1998, Gait & posture.

[25]  R. Waters,et al.  Gait Performance After Spinal Cord Injury , 1993, Clinical orthopaedics and related research.

[26]  R Waters,et al.  Walking and wheelchair energetics in persons with paraplegia. , 1980, Physical therapy.

[27]  J E Lasfargues,et al.  A model for estimating spinal cord injury prevalence in the United States , 1995, Paraplegia.

[28]  N. L. Svensson,et al.  The influence of surface slope on human gait characteristics: a study of urban pedestrians walking on an inclined surface. , 1996, Ergonomics.

[29]  Kathleen E. Norman,et al.  Review : Walking After Spinal Cord Injury: Control and Recovery , 1998 .