Role and Significance of Trunk and Upper Extremity Muscles in Walker-Assisted Paraplegic Gait: A Case Study

Top Spinal Cord Inj Rehabil, 2015 · DOI: 10.1310/sci2101-18 · Published: January 1, 2015

Spinal Cord Injury Rehabilitation Biomechanics

Simple Explanation

This study investigates how trunk and arm muscles are used during walking with a walker in people with spinal cord injuries. Understanding this can help design better assistive devices and muscle strengthening programs. The study recorded muscle activity, movement, and forces during walking in one person with a spinal cord injury who uses a walker and ankle-foot orthoses. The muscle activity was then linked to different parts of the walking cycle. The research found that specific trunk muscles help with balance, lifting the legs, and moving forward during walking. Also, shoulder muscles assist in unloading the legs and ensuring smooth landings.

Study Duration

Not specified

Participants

1 male with SCI (T7 level)

Evidence Level

Level 4; Case Study

Key Findings

1
Reciprocating activation patterns of quadratus lumborum, latissimus dorsi, pectoralis major, and lower trapezius are responsible for trunk extension during balance adjustment, leg unloading, and propulsion force generation.
2
Continuous activation of the rectus abdominis and erector spinae stabilizes the thorax and acts in reverse, fixing the proximal joint and moving the distal limb.
3
Shoulder girdle muscles contribute to leg unloading and smooth landing during leg raising and leg swing phases, respectively.

Research Summary

This case study examined the muscle activation patterns of trunk, upper, and lower extremity muscles during walker-assisted paraplegic gait (WAPG) in an individual with a spinal cord injury. The gait cycle was divided into four phases: balance adjustment, walker propulsion, leg raising, and leg swing. The study associated muscle activation with kinematics and kinetics in each phase. The findings highlight the critical role of trunk and upper extremity muscles in WAPG, suggesting targeted muscle strengthening programs and improved orthotic designs focusing on foot clearance are needed.

Practical Implications

Targeted Muscle Strengthening Programs

Selective strengthening of trunk and upper extremity muscles (TC, PM, LD, LT, RA, ES, EO, IO) can improve gait performance and delay fatigue in paraplegic individuals.

Improved Orthotic Design

Future mechanical gait orthoses should prioritize mechanisms that facilitate foot clearance during the leg raising phase to reduce energy expenditure and muscular fatigue.

Rehabilitation Strategies

Understanding the specific muscle synergies and joint movements in each phase of WAPG can help physical therapists develop more effective rehabilitation strategies for SCI patients.

Study Limitations

1
Single case study limits generalization of results.
2
Surface EMG may have cross-talk from adjacent superficial muscles for deep muscles.
3
Unilateral EMG recordings may not fully capture asymmetrical motor and sensory deficits.

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