Christopher Schmidt Easthope, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland

Gait adaptability: Sensitive assessments for locomotor capacity in incomplete spinal cord injury

Funded in: 2017, 2018, 2019


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Problem: It is challenging to detect small improvements in walking function that are associated with walking quality as opposed to mere changes in walking speed or endurance

Target: Gait adaptability tasks to determine whether an intervention shows promise in improving signal relays between brain and spinal cord

Goal: Measuring and describing walking capacity both quantitatively and qualitatively will enable a sensitive detection of intervention effects.

Spinal cord injury (SCI) is a severe diagnosis that can affect many areas of life and severely impede a patient’s quality of life. One of the frequent consequences of SCI is the loss of walking function, which in paraplegics is often reported as a major limitation in resuming a “normal” lifestyle. Currently, various treatments are being developed that aim at improving or restoring walking function. However, it is challenging to detect small improvements in walking function that are associated with walking quality as opposed to mere changes in walking speed or endurance. To determine in early stages and small population samples whether an intervention shows promise in terms of improving signal relays between brain and spinal cord, we need to design tests that specifically target this compound during walking, as spinal relays behave in an adapted manner during ambulation. This project will explore this niche by way of gait adaptability tasks; tasks that rely on a continuous regulation of motion patterns by supra-spinal centers via selective integration of sensory signals and their transformation into motor commands.

Using state-of-the-art 3D motion capture and electromyography combined with mechanical interfaces and a real-time virtual reality environment, we probe various adaptability tasks and determine their suitability as sensitive and reliable outcome measures. Specifically, we will investigate how SCI patients respond to visual illusions and various mechanical perturbations and describe this in terms of walking stability and adaptive strategies. This will be correlated with measures of spinal cord integrity derived from electrophysiological measurements and clinical evaluations of walking capacity.

The power to capture and reliably describe walking capacity in terms of not just quantity, but also quality, will enable a sensitive detection of intervention effects and has the potential to unveil treatment effects that might otherwise be lost in noise. This can lower the costs of clinical trials and reduce the possibility of negative results due to sub-optimal dosing or application time points. At a time where effective treatments for SCI locomotor impairments are almost a reality, it is vital to ensure that effects are clear, measurable and real. Only what we can measure reliably has a chance in succeeding in an evidence-based clinical setting.