Formation of the locomotor stereotype in patient with consequences of the spinal cord injury (single case)

摘要

Theprocess of emergence of the locomotor act under the influence of training inthe exoskeleton in combination with transcutaneous electrical stimulation ofthe spinal cord has been illustrated in this article on the concrete example ofpatient with the spinal cord injury. It has been revealed, that not simplyimprovement of walking takes place in the process of many-days training, butits appearance. Authors considered the stages of formation of the locomotoract. They revealed the distinctive features of the first steps of patient,appearance of the locomotor act in the process of the first training. Authorsretraced this process from the absence of real walking (ambulation in thewalker with the attached step to emergence of the pathological walking, thendevelopment of phenomena, peculiar to the pathological walking, and at last –formation of more right stereotype of walking. Authors demonstrated, that thefollowing perturbations take place during walking in the exoskeleton: increaseof the support area of the feet and of the extreme values of the ground reactionforce, disappearance of the phenomena of the dynamic and temporal asymmetry,increase of duration of the double-support phase, what causes improvement ofthe biomechanical picture of walking after the session and emergence of thewalking, put pathological one. The following stage is accompanied bydevelopment of the elements of the pathological walking, namely of change ofcorrelation of the stance and swing phase in favour of the stance phase,further increase of duration of the double-support phase, expressed asymmetryof all parameters of walking, presence of the pathological and compensatorymechanisms and, at last, formation of more right stereotype of walking,corresponding with growth of walking velocity and double step length.