Affiliations: SCI Research, Spinal Cord Injury Center, University of
Zurich, Balgrist University Hospital, Zurich, Switzerland
Note: [] Corresponding author: Hubertus J.A. van Hedel, PT, PhD, SCI
Research, Spinal Cord Injury Center, University of Zurich, Balgrist University
Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland. Tel.: +41 44 386 37
30; Fax: +41 44 386 37 31; E-mail: hvanhedel@paralab.balgrist.ch
Abstract: Advances in our understanding of the control of locomotion enable us
to optimize the rehabilitation of patients with a spinal cord injury (SCI).
Based on various animal models, it is generally accepted that central pattern
generators (CPG) exists for the rhythmic generation of stepping movements, and
that this is also the case in humans. However, in humans supraspinal control is
also essential for the performance of locomotion. For regaining locomotor
function, incomplete SCI subjects strongly depend on visual input to compensate
for proprioceptive deficits and impaired balance. In addition, they require
additional attentional capacity to stand, walk and handle their walking aids.
These factors might contribute to their higher risk of falling. During the last
decade, task-specific functional training performed by physiotherapists,
combined with manual or robotic assisted bodyweight supported treadmill
training have improved the regaining of ambulatory function in patients with
incomplete SCI. At present, there is no difference in effectiveness between
these three types of training. In the future, rehabilitation programs should be
optimized to maximally exploit spontaneous and induced neural plasticity,
leading to improved ambulation. To evaluate the efficacy of rehabilitation
programs and of experimental treatments that might be translated from bench to
bedside within the next few years, several objective assessments such as the 10
meter walk test and Walking Index for Spinal Cord Injury have been successfully
introduced in the field of SCI rehabilitation.
Keywords: gait, central pattern generator, motor control, physiotherapy, bodyweight supported treadmill training, gait assessments
