Up to 25 individuals living with chronic incomplete spinal cord injury (iSCI) who can stand but have limited ability to elicit a step without physical assistance or upper limb (U/L) support will be recruited for this study. The first objective of the study will aim to investigate the orthotic effect (i.e., immediate effect) of FES on the reactive stepping response. The second objective is to investigate the therapeutic effect of a novel balance intervention, perturbation-based balance training (PBT) combined with FES (i.e., PBT+FES) on reactive stepping ability, measures of postural sway during quiet standing (i.e., biomechanical measures), and scores on clinical measures of balance and walking.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
2
The PBT program will consist of repetitive practice of reactive stepping for one hour. The participants will be equipped with the Odstock 2-Channel stimulator on one or both sides depending on their deficits. One channel of stimulation may be applied to the common fibular nerve to elicit a flexor withdraw reflex and elicit a step. The second channel of stimulation may be applied to the quadriceps muscles to assist with the supporting phase of the reactive step, as required. Participants will experience about 60 perturbations per session during balance exercises. To create a perturbation, the researcher will apply unexpected pushes or pulls to a safety harness around the participant's trunk. Throughout the hour-long session, participants will complete challenging balance tasks, customized to their ability level, during standing and walking. The training will be supervised by a licensed physiotherapist and administered by a licensed physiotherapist or registered kinesiologist.
Lyndhurst Centre, Toronto Rehabilitation Institute-UHN
Toronto, Ontario, Canada
Lean-and-release test
Test of reactive stepping and balance in the forward direction
Time frame: Up to 7 weeks
Biomechanical measures of postural control
Measurement of centre of pressure during quiet standing
Time frame: Up to 7 weeks
Mini-Balance Evaluation Systems Test
Assesses four balance control systems
Time frame: Up to 7 weeks
Activities-specific Balance Confidence Scale
Assesses balance efficacy
Time frame: Up to 7 weeks
Gait parameters
Step length (cm), gait speed (m/s), double support time (%)
Time frame: Up to 7 weeks
Falls Efficacy Scale International
Assesses the degree of concern about fear of falling
Time frame: Up to 7 weeks
Semi-structured interview
Queries the participants' perceived challenges and benefits of the PBT+FES program
Time frame: 3 months post
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