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UBC Theses and Dissertations

The control of skilled walking: development of novel protocols for assessment of spinal cord injury function and rehabilitation Malik, Raza Naseem


Individuals with partial paralysis due to spinal cord injury (SCI) have difficulties traversing community environments despite intensive gait rehabilitation. Community ambulation requires adapting our gait to obstacles in the walking path that rely on appropriate distribution of visual attention and joint/segment coordination. Motor planning of such skilled movements begins by visually attending (overtly or covertly) to movement-relevant locations, followed by integration of this visual input with somatosensory feedback (mainly proprioceptive) for executing coordinated movements. Because individuals with SCI experience varying levels of proprioceptive impairment, the subsequent effects on movement planning and execution could impact the recovery of community ambulation. In this thesis, I developed novel approaches to assess visual attention and intersegmental dynamics during skilled lower limb movements. The first study presented a novel protocol (in able-bodied controls) to test the deployment of covert (peripheral) visual attention for preparing foot placement during the planning phase of obstacle crossing. We quantified visual attention using an orientation discrimination task and obtained preliminary evidence indicating that visual performance and sensitivity may be modulated as a function of state (walking vs. standing) and location relevance. The second study was a pilot to explore how improvements in walking function may be related to changes in gait kinematics, quantified by joint range of motion and interjoint coordination, in people with SCI. These preliminary data suggest that modifications in knee range of motion and hip-ankle coordination may be related to skilled walking. The third study introduced a novel protocol to assess the impact of proprioceptive deficits after motor-incomplete SCI on lower limb control. Participants performed lower limb pointing to different targets, representing different levels of interjoint coordination with either full or obstructed visual feedback. Our results provide preliminary evidence that this protocol may be used to discern disordered motor-control strategies, especially at the knee, that are associated with proprioceptive impairment. This thesis provides novel protocols to assess important aspects of skilled walking: visual attention for planning foot-placement and intersegmental dynamics for controlling swing limb trajectory. These protocols may be used as tools to identify and evaluate skilled walking behaviour for the recovery of walking after SCI.

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