Stepping responses for reactive balance for individuals with incomplete spinal cord injury

Jae W Lee; Shauna Mauceri; Katherine Chan; Janelle Unger; Kristin E Musselman; Kei Masani

doi:10.1016/j.jbiomech.2023.111519

Stepping responses for reactive balance for individuals with incomplete spinal cord injury

J Biomech. 2023 Apr:151:111519. doi: 10.1016/j.jbiomech.2023.111519. Epub 2023 Mar 2.

Authors

Jae W Lee¹, Shauna Mauceri², Katherine Chan³, Janelle Unger⁴, Kristin E Musselman⁵, Kei Masani⁶

Affiliations

¹ Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3G9, Canada; KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
² Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3G9, Canada.
³ KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
⁴ School of Physical Therapy, Faculty of Health Sciences, Western University, 1201 Richmond St., London, ON N6G 1H1, Canada.
⁵ KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
⁶ Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3G9, Canada; KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada. Electronic address: k.masani@utoronto.ca.

PMID: 36906967
DOI: 10.1016/j.jbiomech.2023.111519

Abstract

Incomplete spinal cord injury (iSCI) causes impairment of reactive balance control, leading to higher fall risk. In our previous work, we found that individuals with iSCI were more likely to exhibit multiple-step response during the lean-and-release (LR) test, where the participant leaned forward while a tether supported 8-12% of the body weight and received a sudden release, inducing reactive steps. Here we investigated the foot placement of people with iSCI during the LR test using margin-of-stability (MOS). Twenty-one individuals with iSCI (age: 56.1 ± 16.1 years old; mass: 72.5 ± 19.0 kg; height: 166 ± 12 cm), and fifteen age- and sex-matched able-bodied (AB) individuals (age: 56.1 ± 12.9 years old; mass: 57.4 ± 10.9 kg; height: 164 ± 8 cm) participated in the study. The participants performed ten trials of the LR test and also completed clinical assessment of balance and strengths, including the Mini-Balance Evaluations Systems Test, the Community Balance and Mobility Scale, gait speed, and lower extremity manual muscle testing. MOS was significantly smaller during multiple-step responses than during single-step responses for both individuals with iSCI and AB counterparts. Using binary logistic regression and receiver operating characteristic analyses, we demonstrated that MOS can distinguish single- and multiple-step responses. In addition, individuals with iSCI demonstrated significantly larger intra-subject variability of MOS compared to AB individuals at first foot contact. Further, we found that MOS correlated with clinical measures of balance including one for reactive balance. We conclude that individuals with iSCI were less likely to demonstrate foot placement with sufficiently large MOS, which may increase the tendency to exhibit multiple-step responses.

Keywords: Balance recovery; Falls; Incomplete spinal cord injury; Margin of stability; Reactive balance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Foot
Humans
Lower Extremity
Middle Aged
Postural Balance* / physiology
Spinal Cord Injuries*
Walking / physiology
Walking Speed