SCI Optimizing Walking Function

Question 1

Positive prognostic factors for recovery of walking

Answer 1

1. AIS D injury
2. less time since injury
3. age <50
4. preservation of pin prick sensation
5. Higher LE motor Scores

Question 2

Negative prognostic factors for recovery of walking

Answer 2

1. AIS A
2. Age >50
3. Cord edema extending multiple levels on MRI
4. more time since injury

Question 3

walking recovery after SCI percentages
1. AIS A
2. AIS B
3. AIS C
4. AIS D

Answer 3

AIS A 14% recover some walkin
AIS B 33% recover some walking
AIS C 75% recover some walking
AIS D 100% recover some waling

Question 4

Extrinsic factors impacting recovery

Answer 4

1. motor learning
2. motor relearning
3. electrical stimulation
4. pharmacology

Question 5

With repetitive presentation of specific sensory information the spinal cord can ______ sensory information and can adapt in a task specific manner

Answer 5

integrate

Question 6

What can we influence

Answer 6

locomotor CPG
Neuroplastic principles
Compensatory strategies

Question 7

Improvement in walking speed and distance in acute onset CNS injury only at _____ intensities and with______ feedback

Answer 7

high intensities with external feedback

Question 8

Why is locomotor CPG important

Answer 8

1. 50% of patients with incomplete SCI or CVA walk
2. walking is a patients priority goal
3. walking correlates with falling, survival rate

Question 9

Clinicians should perform in terms of locomotor training

Answer 9

1. walking training at mod- high intensities
2. walking training coupled with virtual reality

Question 10

Clinicians may consider to promote walking

Answer 10

1. strength training >70% 1 RM
2. circuit training, cycling, recumbent stepping
3. balance training with virtual reality

Question 11

Clinicians should not do this to promote walking

Answer 11

1. static or dynamic balance activities including pre-gait
2. body-weight supported treadmill training with emphasis on kinematics
3. robot assisted gait training

Question 12

training can induce dendritic growth and synapses with specific brain regions that enhance task performance

Answer 12

use it and improve it

Question 13

the nature of training dictates the nature of the plasticity

Answer 13

specificity

Question 14

repetition is required to induce lasting neural changes

Answer 14

repetition matters

Question 15

a sufficient intensity of stimulation is required to induce plasticity

Answer 15

intensity matters

Question 16

what is high intensity

Answer 16

60-80% of HRR
>15/20 on borg scale

Question 17

stepping faster increases muscle activity and _____ locomotor patterns

Answer 17

improves

Question 18

weight bearing _____ muscle activity and _____ locomotor patterns

Answer 18

increases and improves

Question 19

bear weight through legs during transfers
encourage to stand often as possible
lower body weight support

Answer 19

maximize weight bearing on the legs

Question 20

generate sensory information essential for driving neural recovery
focus on upright posture, head, trunk, pelvis and legs
quality practice in addition to quantity

Answer 20

optimize kinematics for each motor task

Question 21

always promoting independence before providing assistance in every motor taks
least restrictive device should be selected when needed for independence, endurance, safety

Answer 21

mimimize compensatory strategies

Question 22

neuronal and cognitive plasticity depend on continual supply of

Answer 22

BDNF

Question 23

Factors that should be considered when prescribing an orthotic

Answer 23

sufficient ROM
Physical and cognitive ability and desire to meet ambulation goals
adequate cardiovascular endurance and UE strength indicated for gait activity

Question 24

KAFO considerations

Answer 24

primary thoracic level
need to have hip extension

Question 25

Research suggests that providing pt in conjunction with using properly fitting _____ appears to confer the same gait and balance benefit as training with and electrical stimulation orthotic device

Answer 25

AFO

Question 26

FES cycling indications

Answer 26

reduce muscle atrophy reduce muscle spasm improve circulation maintain increased range of motion facilitate muscle re-education

Question 27

WPS allows for _____ of sensory and motor neurons

Answer 27

recruitment