Dataset Information

The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury.

ABSTRACT:

Study design

Cross-sectional study.

Objectives

A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI).

Setting

Sunnaas Rehabilitation Hospital, Norway.

Methods

Thirteen men and two women with iSCI and 15 healthy, matched controls were included. Performance of the Berg Balance Scale (BBS) short version (7 items) was used to indicate balance control. Maximal voluntary contraction (MVC) was performed to measure isometric muscle strength in thigh muscles (knee extension/flexion), while surface electromyography (EMG) was measured from M. Vastus Lateralis and M. Biceps Femoris. The relative activation of each muscle during each of the BBS tasks was reported as the percentage of the maximal activation during the MVC (%EMG_max).

Results

The iSCI participants had a significantly lower BBS sum score and up to 40% lower muscle strength in knee- flexion and extension compared to the matched healthy controls. They also exhibited a significantly higher %EMG_max, i.e. a higher muscle activation, during most of the balance tests. Univariate regression analysis revealed a significant association between balance control and mean values of %EMGmax in Biceps Femoris, averaged over the seven BBS tests.

Conclusions

The participants with iSCI had poorer balance control, reduced thigh muscle strength and a higher relative muscle activation in their thigh muscles, during balance-demanding activities.

SUBMITTER: Wouda MF

PROVIDER: S-EPMC10902359 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury.

Wouda Matthijs Ferdinand MF Løtveit Marte Fosvold MF Bengtson Espen Ingvald EI Strøm Vegard V

Spinal cord series and cases 20240228 1

<h4>Study design</h4>Cross-sectional study.<h4>Objectives</h4>A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI).<h4>Setting</h4>Sunnaas Rehabilitation Hospital, Norway.<h4>Methods</h4>Thirteen men and two women with iSCI and 1 ...[more]

PMID: 38418466

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Project description:Key factors positively influencing rehabilitation and functional recovery after spinal cord injury (SCI) include training variety, intensive movement repetition, and motivating training tasks. Systems supporting these aspects may provide profound gains in rehabilitation, independent of the subject's treatment location. In the present study, we test the hypotheses that virtual reality (VR)-augmented training at home (i.e., unsupervised) is feasible with subjects with an incomplete SCI (iSCI) and that it improves motor functions such as lower limb muscle strength, balance, and functional mobility. In the study, 12 chronic iSCI subjects used a home-based, mobile version of a lower limb VR training system. The system included motivating training scenarios and combined action observation and execution. Virtual representations of the legs and feet were controlled via movement sensors. The subjects performed home-based training over 4 weeks, with 16-20 sessions of 30-45 min each. The outcome measures assessed were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Spinal Cord Independence Measure mobility, Walking Index for Spinal Cord Injury II, and 10 m and 6 min walking tests. Two pre-treatment assessment time points were chosen for outcome stability: 4 weeks before treatment and immediately before treatment. At post-assessment (i.e., immediately after treatment), high motivation and positive changes were reported by the subjects (adapted Patients' Global Impression of Change). Significant improvements were shown in lower limb muscle strength (LEMS, P = 0.008), balance (BBS, P = 0.008), and functional mobility (TUG, P = 0.007). At follow-up assessment (i.e., 2-3 months after treatment), functional mobility (TUG) remained significantly improved (P = 0.005) in contrast to the other outcome measures. In summary, unsupervised exercises at home with the VR training system led to beneficial functional training effects in subjects with chronic iSCI, suggesting that it may be useful as a neurorehabilitation tool.Trial registrationCanton of Zurich ethics committee (EK-24/2009, PB_2016-00545), ClinicalTrials.gov: NCT02149186. Registered 24 April 2014.

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.

Dataset Information

The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury.

Study design

Objectives

Setting

Methods

Results

Conclusions

Publications

The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury.

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