title: Postural responses during falling with rapid reach-and-grasp balance reaction in patients with motor complete paraplegia.
abstract: METHODS
  Cross-sectional study.
  
  
  OBJECTIVE
  To investigate the kinematic, kinetic and electromyographic (EMG) aspects of postural control during falling with rapid reach-and-grasp balance reaction in thoracic cord-injured individuals wearing knee-ankle-foot orthoses (KAFOs).
  
  
  METHODS
  Institutional Motion Analysis Laboratory.
  
  
  METHODS
  Seven T7-T12 cord-injured subjects with complete motor loss (ASIA classes A and B) participated in this study. Subjects with KAFOs first stood steady with a modified walker and then released their hold on the walker to maintain self-supported standing until falling with grasping. The center of pressure (COP), center of mass (COM) and joint angles were measured together with EMG of the triceps (TRI), T4 paraspinal and abdominal muscles.
  
  
  RESULTS
  After release of the walker, there was a rapid increase of COM-COP distance (that is, from 13.32+/-11.79 to 54.29+/-24.56 mm), with COM in front of COP during a forward fall, which was associated with the increases of T4 muscle activities. After the reach-and-grasp reaction, COM moved behind COP, which was associated with the increase of ankle dorsiflexion and the TRI and abdominal muscle activities.
  
  
  CONCLUSIONS
  The increase of upper back extensor muscle activity might not be enough to correct postural instability during unsupported stance in thoracic spinal cord injury with complete motor loss. The rapid reach-and-grasp reaction is an alternative compensatory mechanism to prevent falling to the ground.
authors.affiliation: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
authors.forename: K-H
authors.initials: KH
authors.lastname: Lin
authors.forename: T-W
authors.initials: TW
authors.lastname: Lu
authors.forename: P-P
authors.initials: PP
authors.lastname: Hsu
authors.forename: S-M
authors.initials: SM
authors.lastname: Yu
authors.forename: W-S
authors.initials: WS
authors.lastname: Liao
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D001696:Biomechanical Phenomena; D003430:Cross-Sectional Studies; D004576:Electromyography; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009989:Orthotic Devices; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000293:injuries; D014853:Walkers