Dataset Information

The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease.

ABSTRACT:

Objective

To evaluate test-retest reliability, agreement, and convergent validity of the Lean-and-Release test for the assessment of reactive stepping among individuals with incomplete spinal cord injury or disease (iSCI/D).

Design

Multi-center cross-sectional multiple test design.

Setting

SCI/D rehabilitation hospital and biomechanics laboratory.

Participants

Individuals with motor incomplete SCI/D (iSCI/D).

Interventions

None.

Outcome measures

Twenty-six participants attended two sessions to complete the Lean-and-Release test and a battery of clinical tests. Behavioral (i.e. one-step, multi-step, loss of balance) and temporal (i.e. timing of foot off, foot contact, swing of reactive step) parameters were measured. Test-retest reliability was determined with intraclass correlation coefficients, and agreement was evaluated with Bland-Altman plots. Convergent validity was assessed through correlations with clinical tests.

Results

The behavioral responses were reliable for the Lean-and-Release test (ICC = 0.76), but foot contact was the only reliable temporal parameter using data from a single site (ICC = 0.79). All variables showed agreement according to the Bland-Altman plots. The behavioral responses correlated with scores of lower extremity strength (0.54, P<0.01) and balance confidence (0.55, P < 0.01). Swing time of reactive stepping correlated with step time (0.73, P < 0.01) and cadence (-0.73 P < 0.01) of over ground walking.

Conclusions

The behavioral response of the Lean-and-Release test is a reliable and valid measure for people with iSCI/D. Our findings support the use of the behavioral responses to evaluate reactive stepping for research and clinical purposes.

Trial registration

ClinicalTrials.gov identifier: NCT02960178.

SUBMITTER: Unger J

PROVIDER: S-EPMC9135424 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease.

Unger Janelle J Oates Alison R AR Lanovaz Joel J Chan Katherine K Lee Jae W JW Theventhiran Pirashanth P Masani Kei K Musselman Kristin E KE

The journal of spinal cord medicine 20201202 3

<h4>Objective</h4>To evaluate test-retest reliability, agreement, and convergent validity of the Lean-and-Release test for the assessment of reactive stepping among individuals with incomplete spinal cord injury or disease (iSCI/D).<h4>Design</h4>Multi-center cross-sectional multiple test design.<h4>Setting</h4>SCI/D rehabilitation hospital and biomechanics laboratory.<h4>Participants</h4>Individuals with motor incomplete SCI/D (iSCI/D).<h4>Interventions</h4>None.<h4>Outcome measures</h4>Twenty- ...[more]

PMID: 33263499

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Project description:Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.

Project description:BackgroundRobotic-assisted locomotor training has demonstrated some efficacy in individuals with neurological injury and is slowly gaining clinical acceptance. Both exoskeletal devices, which control individual joint movements, and elliptical devices, which control endpoint trajectories, have been utilized with specific patient populations and are available commercially. No studies have directly compared training efficacy or patient performance during stepping between devices.ObjectiveThe purpose of this study was to evaluate kinematic, electromyographic (EMG), and metabolic responses during elliptical- and exoskeletal-assisted stepping in individuals with incomplete spinal cord injury (SCI) compared with therapist-assisted stepping. Design A prospective, cross-sectional, repeated-measures design was used.MethodsParticipants with incomplete SCI (n=11) performed 3 separate bouts of exoskeletal-, elliptical-, or therapist-assisted stepping. Unilateral hip and knee sagittal-plane kinematics, lower-limb EMG recordings, and oxygen consumption were compared across stepping conditions and with control participants (n=10) during treadmill stepping.ResultsExoskeletal stepping kinematics closely approximated normal gait patterns, whereas significantly greater hip and knee flexion postures were observed during elliptical-assisted stepping. Measures of kinematic variability indicated consistent patterns in control participants and during exoskeletal-assisted stepping, whereas therapist- and elliptical-assisted stepping kinematics were more variable. Despite specific differences, EMG patterns generally were similar across stepping conditions in the participants with SCI. In contrast, oxygen consumption was consistently greater during therapist-assisted stepping. Limitations Limitations included a small sample size, lack of ability to evaluate kinetics during stepping, unilateral EMG recordings, and sagittal-plane kinematics.ConclusionsDespite specific differences in kinematics and EMG activity, metabolic activity was similar during stepping in each robotic device. Understanding potential differences and similarities in stepping performance with robotic assistance may be important in delivery of repeated locomotor training using robotic or therapist assistance and for consumers of robotic devices.

Dataset Information

The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease.

Objective

Design

Setting

Participants

Interventions

Outcome measures

Results

Conclusions

Trial registration

Publications

The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease.

Similar Datasets

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