title: Using a divided-attention stepping accuracy task to improve balance and functional outcomes in an individual with incomplete spinal cord injury: A case report.
abstract: A spinal cord injury (SCI) frequently results in impaired balance, endurance, and strength with subsequent limitations in functional mobility and community participation. The purpose of this case report was to implement a training program for an individual with a chronic incomplete SCI using a novel divided-attention stepping accuracy task (DASAT) to determine if improvements could be made in impairments, activities, and participation. The client was a 51-year-old male with a motor incomplete C4 SCI sustained 4 years prior. He presented with decreased quality of life (QOL) and functional independence, and deficits in balance, endurance, and strength consistent with central cord syndrome. The client completed the DASAT intervention 3 times per week for 6 weeks. Each session incorporated 96 multi-directional steps to randomly-assigned targets in response to 3-step verbal commands. QOL, measured using the SF-36, was generally enhanced but fluctuated. Community mobility progressed from close supervision to independence. Significant improvement was achieved in all balance scores: Berg Balance Scale by 9 points [Minimal Detectable Change (MDC) = 4.9 in elderly]; Functional Reach Test by 7.62 cm (MDC = 5.16 in C5/C6 SCI); and Timed Up-and-Go by 0.53 s (MDC not established). Endurance increased on the 6-Minute Walk Test, with the client achieving an additional 47 m (MDC = 45.8 m). Lower extremity isokinetic peak torque strength measures were mostly unchanged. Six minutes of DASAT training per session provided an efficient, low-cost intervention utilizing multiple trials of variable practice, and resulted in better performance in activities, balance, and endurance in this client.
authors.affiliation: a Department of Physical Therapy and Health Care Sciences , The George Washington University , Washington , DC , USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Leach
authors.affiliation: b Department of Biobehavioral Sciences , Teachers College, Columbia University , New York , NY , USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Magill
authors.affiliation: a Department of Physical Therapy and Health Care Sciences , The George Washington University , Washington , DC , USA.
authors.forename: Joyce R
authors.initials: JR
authors.lastname: Maring
mesh_terms: D001288:Attention; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000503:physiopathology*; D002908:Chronic Disease; D051341:Dependent Ambulation; D005080:Exercise Test; D017079:Exercise Tolerance; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009043:Motor Activity; D053580:Muscle Strength; D026741:Physical Therapy Modalities; D004856:Postural Balance; D011788:Quality of Life; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D019415:Torque; D016896:Treatment Outcome
keywords: Procedural learning; spinal cord injury; variable practice