Exam 3 question

[Harriet Hill]

Which of the following is not a recommendation for locomotor training after spinal cord injury?

a. Maximize weight-bearing through lower extremities
b. Select walking speeds as close to “normal” as possible
c. Minimize compensatory strategies
d. Minimize level of assistance with use of appropriate bracing

The principles of locomotor training are maximizing load through lower extremities, optimizing sensory cues (including avoiding use of braces and assistive devices), promoting normal kinematics, and avoiding compensations.

Hi Chrissy, just a question about this one from practice exam three. Is this based on the locomotor CPG, or on another guide line related only to spinal cord injury? I had chosen answer C, minimize compensatory strategies, just thinking that right now an impairment based approach is not recommended. I did not choose answer D because I feel like we do want to minimize the level of hands-on assistance we’re providing, and if we are trying to maximize weight-bearing and increased walking speeds it is important to choose preaching that can protect joints so as tonight cause long-term damage. Can you help me think this through? I can understand avoiding use of assistive devices, but I can’t really understand avoiding the use of appropriate bracing.

[Chrissy Durrough Lugge]

Hi Harriet,

I am going to revise this question a bit to be more clear. The question specifically pertains to the Behrman and Harkema article and treadmill training. Walking at faster speeds with maximal weight-bearing taps into our central pattern generators to facilitate a more normal and reflexive walking pattern. For treadmill training, it can be beneficial to minimize bracing- and provide manual facilitation to tap into those CPGs and minimize compensatory patterns.

For functional overground walking, bracing is necessary and effective for many individuals post-SCI. In the right circumstances and with adequate manual assistance, some of these patients may benefit from treadmill training without bracing.

Chrissy

[Aushem]

Was this article mentioned in the SCI interventions section of your lecture? I cannot remember off the top of my head. Thanks.

[Chrissy Durrough Lugge]

No, I took it out of the updated lecture because there is more current literature available since the CPG was published. This was a pretty big article when it came out and for the 10 years or so following. Here’s the link: https://www.pmr.theclinics.com/article/S1047-9651(07)00018-6/abstract

I am currently working through lecture updates. Once those are complete, I am going to comb through all the practice exams and do updates there, so some of these questions will be phased out.

[Shahnaj Alam]

Good afternoon,

I just completed practice exam 3 and was looking through the forum before posting. I understand the rationale behind the question but noticed that the question was not changed since this initial post. I also found the question a bit confusing as I typically think of the CPG recommendations and felt like this one was a little misleading. Thank you for the work you have put into our lectures and exams.

[Chrissy Durrough Lugge]

Hi Shahnaj! In 2024 and 2025, my focus was on updating the foundational and diagnosis-specific lectures. In 2026, we are going to refresh all the exam questions. I am on maternity leave right now and will hit the ground running on that in March!

[Shahnaj Alam]

All good! Congrats!!!

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