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Ambulatory and Secondary Complications


Ambulation and Secondary Complications:
Participants with Chronic Spinal Cord Injury

As breakthroughs in basic science become translated into clinical practice and restorative interventions succeed in preserving or enhancing neurologic function, the proportion of individuals who ambulate after spinal cord injury (SCI) will no doubt increase. Understanding the complications associated with ambulation is an essential step in the successful translation of these breakthroughs in successful practice. The widespread assumption is that future breakthroughs will eventually lead to a “cure” for SCI, which many interpret as complete ambulation with no adverse long‐term consequences of the SCI. Few concerns have been raised regarding possible new problems that limit, rather than enhance, quality of life. Similarly, the viability of future functional interventions with individuals who have accrued a substantial number of secondary conditions in the years and decades with SCI has not been questioned. Rehabilitation, by definition, mandates that breakthroughs are measured in terms of ability to live each day with one's disability in a manner that increases participation and QOL (rather than physical function alone).

This study will guide rehabilitation professionals’ efforts to enhance health, participation, and QOL by helping us to understand when ambulation is not the optimal mode of locomotion or promoting better outcomes. Identifying the patterns of ambulation that are associated with diminished health, participation, and QOL and some of the factors that mediate these relationships will both guide rehabilitation professionals’ practices and directly empower consumers by providing concrete information to help them make more educated decisions regarding ambulation. Lastly, this study will also lay the foundation for future research using motion analysis and force plates technology to further investigate problematic gait patterns (identified in the proposed study) in a laboratory setting where the specific movement may be studied in greater detail as a prelude to, or in conjunction with, clinical interventions.

The purpose of this study is to identify variations in ambulation after SCI based on utilization of assistive devices and orthoses, reliance on people for assistance, functionality (distances, primary mode of locomotion), and association with secondary conditions. Specifically, we will test a mediational model to determine the extent to which pain and fatigue mediate the relationships between ambulation parameters and participation, depressive symptoms, and QOL.

Funding Agency: National Institutes on Disability and Rehabilitation Research ( H133G090059 (2009-2012)

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