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Locomotor recovery after incomplete spinal cord injury (iSCI) is influenced by spinal and supraspinal networks. Conventional clinical gait analysis fails to differentiate between these components. There is evidence that corticospinal control is enhanced during targeted walking, where each foot must be continuously placed on visual targets in randomized order. This study investigates the potential of targeted walking in the functional assessment of corticospinal integrity. Twenty-one controls and 16 individuals with chronic iSCI performed normal and targeted walking on a treadmill while electromyograms (EMGs) and kinematics were recorded. Precision (% of accurate foot placements) in targeted walking was significantly lower in individuals with iSCI (82.9 ± 14.7%, controls: 94.9 ± 4.0%). Although the overall kinematic pattern was comparable between walking conditions, controls showed significantly higher semitendinosus (ST) activity before heel-strike during targeted walking. This was accompanied by a shift of relative EMG intensity from 90-120 Hz to lower frequencies of 20-60 Hz, previously associated with corticospinal control of muscle activity. Targeted walking in individuals with iSCI evoked smaller EMG changes, suggesting that the switch to more corticospinal control is impaired. Accordingly, mildly impaired iSCI individuals revealed higher adaptations to the targeted walking task than more-impaired individuals. Recording of EMGs during targeted walking holds potential as a research tool to reveal further insights into the neuromuscular control of locomotion. It also complements findings of pre-clinical studies and is a promising novel surrogate marker of integrity of corticospinal control in individuals with iSCI and other neurological impairments. Future studies should investigate its potential for diagnosis or tracking recovery during rehabilitation.

In healthy subjects, changes in arm swing symmetry while walking are observed when a cognitive dual task is added, with a tendency toward left-dominant arm swing as cognitive load increases. We applied a modified Stroop word/color naming paradigm to investigate this effect in spinal cord injured (SCI) patients. Six patients with cervical SCI (cSCI), 6 with thoracic injuries (tSCI; all 12 patients American Spinal Injury Association [ASIA] Injury Score [AIS]D), and 12 healthy, matched controls underwent three-dimensional 3D gait analysis while walking normally at a comfortable speed (NW) and when performing an additional congruent (CS) and incongruent (IS) Stroop task. An arm swing symmetry index (ASI)-in which positive values indicate proportionally more movement on the left and vice versa-was calculated. Even in the baseline NW condition, all three subject groups showed larger arm movements on the left. In controls, ASI increased (NW, 13.7 ± 6.3; CS, 16.6 ± 6.4; IS, 19.6 ± 7.8) as the task became more demanding. A larger shift in tSCI patients (NW, 15.8 ± 6.0; CS, 23.4 ± 3.8; IS, 30.7 ± 4.4) was driven by a significant reduction in right wrist trajectory (p = 0.014), whereas cSCI patients showed a small reduction in mean ASI with high variability (NW, 14.2 ± 10.7; CS, 9.3 ± 13.5; IS, 6.0 ± 12.9). The effect of the IS task on ASI compared to baseline (NW) was significantly different between tSCI (+12.5 ± 6.3) and cSCI (-8.2 ± 6.0) patients (p = 0.011). Disruption of the long propriospinal connections coordinating arm and leg movements during walking may explain the heightened sensitivity to manipulation of cognitive load in tSCI, whereas the more robust automaticity in cSCI may be attributed to impaired supraspinal inputs in the context of preserved intraspinal pathways.

We studied the influence of levodopa (L-Dopa) on training effects in subjects with spinal cord injury (SCI). A low-dose of L-Dopa per day is known to enhance the effects of physical training after stroke. This is tested here in subjects suffering a SCI. Twelve subacute, incomplete SCI (iSCI) subjects (ASIA C and D) were randomized in a trial with a double-blind, crossover design to receive 6 weeks of L-Dopa (200 mg), followed by 6 weeks of placebo, or vice versa. Outcome measures were ASIA Motor-Score (AMS) reflecting motor recovery; walking ability, assessed by the Walking Index of Spinal Cord Injury (WISCI); and Activities of Daily Living (ADL), as monitored by the Spinal Cord Independence Measure (SCIM). Both placebo and L-Dopa, in combination with physiotherapy, produced a significant motor recovery after SCI. The combination of L-Dopa and physiotherapy had no greater effect on the outcome than placebo and physiotherapy. The possible reasons for the different effect of L-Dopa in stroke and iSCI subjects are discussed.

We studied the influence of levodopa (L-Dopa) on training effects in subjects with spinal cord injury (SCI). A low-dose of L-Dopa per day is known to enhance the effects of physical training after stroke. This is tested here in subjects suffering a SCI. Twelve subacute, incomplete SCI (iSCI) subjects (ASIA C and D) were randomized in a trial with a double-blind, crossover design to receive 6 weeks of L-Dopa (200 mg), followed by 6 weeks of placebo, or vice versa. Outcome measures were ASIA Motor-Score (AMS) reflecting motor recovery; walking ability, assessed by the Walking Index of Spinal Cord Injury (WISCI); and Activities of Daily Living (ADL), as monitored by the Spinal Cord Independence Measure (SCIM). Both placebo and L-Dopa, in combination with physiotherapy, produced a significant motor recovery after SCI. The combination of L-Dopa and physiotherapy had no greater effect on the outcome than placebo and physiotherapy. The possible reasons for the different effect of L-Dopa in stroke and iSCI subjects are discussed.