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The role of the arms in the rehabilitation of walking after incomplete spinal cord injury Open Access


Other title
Task-specific training
Rhythmic movements
Corticospinal pathway
Spinal cord injury
Interlimb coordination
Locomotor training
Type of item
Degree grantor
University of Alberta
Author or creator
Zhou, Rui
Supervisor and department
Mushahwar, Vivian K. (Division of Physical Medicine & Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry)
Examining committee member and department
Thompson, Richard (Biomedical Engineering)
Lam, Tania (School of Kinesiology, University of British Columbia)
Yang, Jaynie (Physical Therapy)
Prochazka, Arthur (Physiology)
Centre for Neuroscience

Date accepted
Graduation date
2016-06:Fall 2016
Doctor of Philosophy
Degree level
The overall goal of this dissertation was to develop a novel rehabilitative intervention to improve walking after incomplete spinal cord injury (iSCI). It is widely known that arm movement modulates leg activity and improves the efficiency of gait. However, gait-specific rehabilitation interventions focused on the lower limbs often neglect the involvement the arms, and primarily focus on gait-specific leg training only such as locomotor training, for restoring walking after injury or disease. To date, the effect of arms in the rehabilitation of walking after neural disorders has not been investigated. As a pilot study, I introduced a non-gait-specific rehabilitation strategy that involves simultaneous arm and leg cycling, assisted by functional electrical stimulation (FES), on improving walking in people with chronic iSCI. Specifically, I compared the training outcomes with those from study participants trained with leg cycling only. I investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in overground walking capacity. Overall, both cycling training interventions resulted in substantial improvements in walking capacity after chronic iSCI; more importantly, participants trained with combined arm&leg cycling had better improvement in walking speed, distance, spatiotemporal parameters of gait, consistency of joint coordination and regulation of muscle EMG activity, relative to those in participants trained with leg cycling only. This indicated that active involvement of the arms simultaneously with the legs, produces better training improvements in rehabilitation for walking than engaging the legs alone. I also investigated the changes to the spinal and corticospinal pathways as a function of training. I found that spinal cervico-lumbar connectivity in people with chronic iSCI was impaired, exemplified by the absence of modulation of H-reflexes during rhythmic movements. Nonetheless, I found that the modulation could be restored, to some extent, through cycling training. I also found that dynamic arm movement strongly facilitated the corticospinal pathway to the legs in participants with intact nervous system, but this facilitation was abolished after iSCI. Although there are improvements in the corticospinal pathway after both modes of cycling training, the improvement was only significant in the participants trained with combined arm and leg cycling. Therefore, actively engaging the arms during training can significantly improve the strength of the corticospinal pathway to the legs. To the best of my knowledge, this was the first study systematically identified the role of the arms in the rehabilitation of walking after iSCI. The findings collectively suggest that FES-assisted arm and leg cycling could provide larger improvements in overground walking capacity than paradigms focusing on leg training only. This work also provided evidence that supports the translation of rhythmic non-gait-specific training, such as cycling, to improvements in overground walking. The outcomes of this work may be instrumental in the development of future rehabilitation interventions after neural disorders.
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