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European Journal of Physical and Rehabilitation Medicine 2020 Aug 03

DOI: 10.23736/S1973-9087.20.06333-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury

Teerawat NITHIATTHAWANON 1,4, Pipatana AMATACHAYA 2,4, Thiwabhorn THAWEEWANNAKIJ 1,4, Nuttaset MANIMMANAKORN 3,4, Lugkana MATO 1,4, Sugalya AMATACHAYA 1,4

1 School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; 2 Department of Mechanical Engineering, Faculty of Engineering and
Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand; 3 Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4 Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand


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BACKGROUND: Data relating to weight-bearing or lower limb loading ability (LLLA) has been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration.
AIM: To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals.
DESIGN: Cross-sectional study.
SETTING: Tertiary rehabilitation centres and communities.
POPULATION: Ninety ambulatory participants with SCI.
METHODS: Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months.
RESULTS: Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94%-95% of the bodyweight had moderate
diagnostic properties to indicate the independence and safety of these individuals (sensitivity = 68%-77%, specificity = 66%-81%, and AUC = 0.73-0.80).
CONCLUSIONS: The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal
threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings.
CLINICAL REHABILITATION IMPACT: The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94%-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and homebased settings, specifically for ambulatory individuals with SCI.


KEY WORDS: Weight-bearing; Fall; Rehabilitation; Walker; Walking

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