Characterization of standing balance after incomplete spinal cord injury: Alteration in integration of sensory information in ambulatory individuals.

Abstract:

BACKGROUND:Up to one-third of individuals with a recent spinal cord injury (SCI) and most of the individuals with an incomplete lesion are able to regain partial balance and walking ability after the first-year post-injury. However, most individuals experience injurious falls while standing and frequent losses of balance post-rehabilitation, which can result in physical injuries and a fear of falling. RESEARCH QUESTION:Control of balance during quiet standing depends on the integration of sensory information. Since SCI causes sensory and motor impairments, understanding the underlying mechanisms of how postural control is regulated is of significant importance for targeted and guided rehabilitation post-SCI. METHODS:We characterized the impact of a variety of challenging conditions on the standing balance for eight participants with incomplete SCI with walking ability compared to twelve age-matched able-bodied individuals using a waist-mounted inertial measurement unit (IMU). We compared balance biomarkers derived from IMUs' readouts under conditions that challenged balance by affecting somatosensory (i.e., standing on hard vs. foam surfaces) and visual (i.e., eyes open vs. closed) inputs. We performed a three-way ANOVA or a Kruskal-Wallis test to characterize changes in postural control post-SCI based on reliance on somatosensory and visual information using balance biomarkers. RESULTS:We observed a reduced stability performance, an increased control demand, and a less effective active correction post-SCI in all standing conditions. Due to impaired somatosensory feedback, individuals with incomplete SCI showed a higher and lower reliance on visual and somatosensory information, respectively, for maintaining balance (p < 0.05). SIGNIFICANCE:Using a single waist-mounted IMU, the proposed method could characterize standing balance in individuals with incomplete SCI compared to able-bodied participants. Having high clinical utility and sufficient resolution with discriminatory ability, our method could be used in the future to objectively evaluate the effectiveness of rehabilitative interventions on the balance performance of individuals with SCI.

journal_name

Gait Posture

journal_title

Gait & posture

authors

Noamani A,Lemay JF,Musselman KE,Rouhani H

doi

10.1016/j.gaitpost.2020.10.027

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

152-159

eissn

0966-6362

issn

1879-2219

pii

S0966-6362(20)30607-X

journal_volume

83

pub_type

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