To investigate long-term effects of SmartDrive on mobility, everyday activity, and shoulder pain among spinal cord injured manual wheelchairs users.A prospective pilot intervention study was conduc...

This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden’s largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.

Spinal cord injury (SCI) can impair sensorimotor pathways and reduce walking ability. The effects of sensorimotor impairments are complex, as they interact with other factors such as age, pain, injury level, and injury severity. Traditional regression analyses have been used to describe relationships, but they frequently assume linearity. Explainable AI methods such as SHapley Additive ex-Planations (SHAP), based on cooperative game theory, can reveal feature importance globally and locally. Gaussian Process Regression (GPR) can handle limited datasets, a common challenge in observational clinical studies with small sample sizes. In this study, we proposed and evaluated a framework applying GPR and SHAP to quantify how neurological impairments and other factors, including muscle strength, sensory function, age, pain, spasticity, etc., contribute to walking performance, specifically walking speed and net oxygen cost during a six-minute walk test. This approach estimates each factor’s contribution both on a group level and for each individual. Thirty four adults with SCI underwent a clinical assessment and the six-minute walk test with preferred walking aids if relevant. Muscle strength was the most influential factor in both walking speed and net oxygen cost. Male sex, lower age, and less pain were associated with increased walking speed. More pain, higher body mass index, and higher sensory score were associated with lower net oxygen cost. Spasticity, injury level and sensory injury levels had relatively small influence on either outcome measure. Individual SHAP analyses quantified how neurological factors influenced walking performance for each participant. We demonstrate how nonparametric regression and explainable AI provide insights into the complex neurological factors affecting walking ability in persons with SCI.

Study design: Psychometric study. Objectives: To evaluate the data completeness, data distribution and ceiling/floor effects, internal consistency and convergent validity of the Swedish versions of the Spinal Cord Independence Measure IV (s-SCIM IV) and the Spinal Cord Independence Measure Self-report (s-SCIM-SR). Setting: Swedish inpatient and outpatient spinal cord injury (SCI) rehabilitation. Methods: The translation process was based on established guidelines with researchers, clinicians and consumers. s-SCIM IV and FIM ^TM assessments were performed by observation and/or interview, s-SCIM-SR through self-report using paper forms. Results: In total, 101 participants (82% men) were included. There were no missing data for s-SCIM IV and 92% had answered all items in s-SCIM-SR. No ceiling or floor effects were observed. Cronbach´s alpha for the total s-SCIM IV scale was 0.91 (subscales 0.68–0.93) and for the total s-SCIM-SR scale 0.91 (subscales 0.62–0.93), with the lowest alphas for Respiration and Sphincter Management in both outcome measures. s-SCIM IV and s-SCIM-SR correlated strongly with each other and with FIM ^TM . Conclusions: Our results support the data completeness, lack of ceiling/floor effects, internal consistency (except the Respiration and Sphincter Management subscale) and convergent validity of the s-SCIM IV and s-SCIM-SR. Based on this initial psychometric testing, these outcome measures can be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The now available Swedish versions of SCIM will enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons.

Study design: Cross-sectional design. Objectives: To study motor-cognitive interaction during walking while performing a cognitive task (dual-task [DT]) in ambulatory adults with spina bifida (SB). Setting: A specialized spinal cord center, The Spinalis clinic at Aleris Rehab Station Stockholm, Sweden. Methods: Assessments of muscle strength and ambulatory function were performed. Gait was assessed with a sensor-based system with/without the auditory Stroop. Timed-up-and-go (TUG) with/without a cognitive task was also assessed. Regarding cognitive function, episodic memory, executive function, and processing speed were assessed. The percentage of difference between single-task (ST) and dual-task (DT) was used to calculate the DT effect (DTE) as cost or benefit. Differences were analyzed with t-test and Wilcoxon’s signed rank test. Results: Forty-one persons were included, mean age 37 years (SD 12) and 20 (49%) were women. Thirty-four completed the DTE analysis. Seven could not perform the cognitive task and/or gait data and could not be registered. There was a DT cost on gait speed (4%), stride length (3%) and double support phase (3%), and cognitive function showed a cost of 3%. DTE for TUG was a 26% cost. Conclusion: We showed a DT cost on gait, possibly indicating fall risk during DT walking. The largest DT cost was seen during TUG with a cognitive task, indicating a valuable clinical test for motor-cognitive performance for adults with SB. This study is pioneering in that it increases our understanding of DT performance in ambulatory adults with SB which could facilitate development of targeted rehabilitation interventions and self-management strategies.