156 196 226 230 240 268 307 Days after SCI
Figure 19.4. Data from three patients with incomplete paraplegia after SCI. In three individual patients (a-c) undergoing locomotor training, there is a differential course of motor score, which reflects the ability to voluntary contract selected muscles, and locomotor function with respect to time. The motor score is assigned according to ASIA standards, with a maximum score of 50. The WISCI (walking index for SCI) score ranges from 0 (no walking ability) to 19 (full walking ability) (from Dietz, 2002a).
function, the superiority of any new interventional therapy on functional movements might reliably be assessed (see also Volume II, Chapter 3).
The advantage of gait analysis represents the quantitative assessment of a functional movement with its underlying neuronal mechanisms and biomechani-cal consequences. In the future, this approach may further be developed to extract the factors responsible for a movement disorder. For future application in the rehabilitation field, gait analysis may help to select the most effective pharmacological and phys-iotherapeutical approaches. This may not only be of benefit for the patient but also could lead to reduced health care costs as most physiotherapeutic approaches are not based on controlled studies and their effectiveness was never convincingly demonstrated. For future application in the clinical diagnosis, gait analysis may help to achieve an early diagnosis and detection of subtypes of a movement disorder with the consequence of an early onset of an appropriate training (for review see Dietz, 2002a).
With the gait analysis of patients with a central motor lesion, the best therapeutical approach and the effect of any treatment on the locomotor can be determined. Such an analysis has revealed, for example, that the development of spastic muscle tone can be advantageous, in that it provides body support during stepping movements. This knowledge has, of course, consequences for physiotherapy and drug application.
In severely affected paretic patients the strength of leg muscle activation is not sufficient to build up enough muscle tone or to control limb movements for locomotion. One approach to enhance spinal locomotor activity in the patients with incomplete and complete paraplegia represents the search for substances which influence the gain of leg extensor EMG activity. The most promising approach for the future may be to induce partial regeneration of the lesioned spinal cord tract fibres. Recent experiments in the rat have indicated that after inhibition of neu-rite growth inhibitors, partial regeneration can occur (for review see Schwab, 1991; Schwab and Bartholdi, 1996). Connected with appropriate locomotor training this approach may improve functional mobility even that of almost completely paraplegic patients. Electrophysiological and biomechanical recordings of locomotion in rats with spinal cord lesions has provided information that this model can be applied in humans with SCI (Metz et al., 2000).
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