Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;58(2):185-193.
doi: 10.1038/s41393-019-0332-y. Epub 2019 Jul 29.

Reactive stepping after a forward fall in people living with incomplete spinal cord injury or disease

Katherine Chan  1 , Jae Woung Lee  1   2 , Janelle Unger  1   3 , Jaeeun Yoo  1   2 , Kei Masani  1   2 , Kristin E Musselman  4   5   6
Affiliations

Reactive stepping after a forward fall in people living with incomplete spinal cord injury or disease

Katherine Chan et al. Spinal Cord. 2020 Feb.

Abstract

Study design: Cross sectional.

Objectives: To compare the reactive stepping ability of individuals living with incomplete spinal cord injury or disease (SCI/D) to that of sex- and age-matched able-bodied adults.

Setting: A tertiary SCI/D rehabilitation center in Canada.

Methods: Thirty-three individuals (20 with incomplete SCI/D) participated. Participants assumed a forward lean position in standing whilst 8-12% of their body weight was supported by a horizontal cable at waist height affixed to a rigid structure. The cable was released unexpectedly, simulating a forward fall and eliciting one or more reactive steps. Behavioral responses (i.e., single step versus non-single step) were compared using a Chi-square test. The following temporal parameters of reactive stepping were compared using t-tests: the onset of muscle activation in 12 lower extremity muscles (six per limb) and step-off, step contact and swing time of the stepping leg.

Results: Behavioral responses were significantly different between groups (χ2 = 13.9 and p < 0.01) with participants with incomplete SCI/D showing more non-single step responses (i.e., multi-steps and falls). The onsets of muscle activation were more variable in participants with incomplete SCI/D, but only the stepping tibialis anterior showed a significantly slower onset in this group compared with able-bodied adults (t = -2.11 and p = 0.049). Movement timing of the stepping leg (i.e., step-off, step contact, and swing time) was not significantly different between groups.

Conclusions: Reactive stepping ability of individuals with incomplete SCI/D is impaired; however, this impairment is not explained by temporal parameters. The findings suggest that reactive stepping should be targeted in the rehabilitation of ambulatory individuals with SCI/D.

PubMed Disclaimer

References

    1. Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg. 2018. https://doi.org/10.1016/j.wneu.2018.02.033 - PubMed
    1. Mathiyakom W, McNitt-Gray J. Regulation of angular impulse during fall recovery. J Rehabil Res Dev 2008;45:1237–48. - PubMed
    1. Pollock AS, Durward BR, Rowe PJ. What is balance? Clin Rehabil 2000;14:402–6. - PubMed
    1. Day KV, Kautz SA, Wu SS, Suter SP, Behrman AL. Foot placement variability as a walking balance mechanism post-spinal cord injury. Clin Biomech. 2012;27:145–50.
    1. Arora T, Musselman KE, Lanovaz J, Linassi G, Arnold C, Milosavljevic S et al. Walking stability during normal walking and its association with slip intensity among individuals with incomplete spinal cord injury. 2018. https://doi.org/10.1016/j.pmrj.2018.07.012

LinkOut - more resources