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Andrea Behrman PT PhD University of Florida Dr. Asmita Karajgi Associate Professor Dept of Physiotherapy Pad. Dr. D Y Patil University Nerul, Mumbai.

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Presentation on theme: "Andrea Behrman PT PhD University of Florida Dr. Asmita Karajgi Associate Professor Dept of Physiotherapy Pad. Dr. D Y Patil University Nerul, Mumbai."— Presentation transcript:

1 Andrea Behrman PT PhD University of Florida Dr. Asmita Karajgi Associate Professor Dept of Physiotherapy Pad. Dr. D Y Patil University Nerul, Mumbai

2  Promising experimental approach  Improves speed endurance step symmetry obstacle negotiation

3  Case description- 4.5 yr old boy 16 weeks post injury(gunshot wound) low cervical spinal cord injury 3 months of inpatient rehabilitation+10 mth of outpatient rehabilitation improved from AIS –A to AIS –C with bilat C 8 function ‘a lot of extensor tone in quadriceps and no voluntary hip flexion,ankle or toe movement’ could not stand independently prognosis-wheelchair bound

4 prior to training – ROM spasticity (quadriceps-2 &Plantar flexors-1) ASIA impairement scale(Plantar flexors-2 for each leg)

5  76 sessions of locomotor training  20-30 minutes of step training with BWS on treadmill followed by 10-20 minutes of overground training with graded sensory cues.  Assistance at the pelvis,trunk and each lower limb  Training 5 times per week –45 sessions—76 sessions

6 Upright posture &LE weight bearing without upper limb weight bearing Limb co-ordination with arm swing Aim of approximating normal walking speed  5 min –bout of step training on treadmill(stretches to hip flexors and dorsiflexors) followed by bout of stand training(BWS was reduced,manual pressure to knee and ankle extensors)  Transfer to overground training

7  ASIA –SAME (AIS –C with bilat C 8 function)  Only hip flexors improved from 0 to 1 after 74 sessions  Locomotor recovery-  Baseline-nonambulatory  22 sittings-slight activity of ext and improved shoulder alignment with pelvis  After 6 sessions of intense cueing-active contribution to stepping  Noncued steps  After 18 sessions (51-76)-independent use of posterior rolling walker

8  Walking index score from 0 to 13/20 but no change in LEMS  Gait speed 0.29m/s(self selected) &0.48 (maximum )  2488 community based steps.  Recovery only locomotor dependent

9  SPGL-  2 components – 1 using sensory input by trainers 2 activation of SPGL by the patient  Cortico brainstem spinal system activation

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