Gait function can be altered after incomplete spinal cord (iSCI) lesions. Muscular weakness, co‐activation of antagonist muscles, and altered muscle mechanics are likely to provoke abnormal gait and postural movements. Functional scales are available for assessment of functional walking in SCI patients, such as walking index for spinal cord injury (WISCI II), timed up and go (TUG) test, 10‐meter walk test (10MWT), and 6‐minute walk test (6MWT). Novel metrics for a more detailed comprehension of neuromuscular control in terms of degree of voluntary motor control have been recently proposed. This section describes novel techniques based on muscle synergy and frequency domain analysis of electromyographic signals. Such techniques are illustrated as potential tools for assessment of motor function after SCI with experimental data and a case study describing a diagnostic scenario. This chapter presents a discussion of the current status of the emerging metrics for assessment of sensorimotor impairments. Conclusions are given with respect to the availability of enriched information about neuromuscular behavior between functional tasks (walking and pedalling) and the potential relevance of these new techniques to improve the efficacy of treatment to improve locomotion after iSCI.
Part of the book: Recovery of Motor Function Following Spinal Cord Injury
In the past three decades, research on plasticity after spinal cord injury (SCI) has led to a gradual shift in SCI rehabilitation: the former focus on learning compensatory strategies changed to functional neurorecovery, that is, promoting restoration of function through the use of affected limbs. This paradigm shift contributed to the development of technology-based interventions aiming to promote neurorecovery through repetitive training. This chapter presents an overview of a range of noninvasive modalities that have been used in rehabilitation after SCI. Among others, we present repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface electrical stimulation tools such as transcutaneous electrical spinal cord stimulation (tcSCS), transcutaneous electrical nerve stimulation (TENS), and functional electrical stimulation (FES), as well as its integration with cycling training and assistive robotic devices. The most recent results attained and the potential relevance of these new techniques to strengthen the efficacy of the residual neuronal pathways and improve spasticity are also presented. Future efforts toward the widespread clinical application of these modalities include more advances in the technology, together with the knowledge obtained from basic research and clinical trials. This can ultimately lead to novel customized interventions that meet specific needs of SCI patients.
Part of the book: Spinal Cord Injury Therapy