The effects of a novel lower limb proprioception training intervention on skilled walking performance for individuals with a spinal cord injury

Introduction: Proprioception gives us the ability to know the location of our limbs in space. It plays a critical role in movement control, including walking. After a spinal cord injury (SCI), individuals experience not only weakness or paralysis, but also proprioceptive deficits, which further compound difficulties with movement control. In this study, we tested the effects of a new robotic-based protocol to train proprioceptive sense in the lower limbs and assessed whether improvements in proprioceptive sense could also improve performance of a skilled walking task in people with SCI. Methods: Skilled walking performance was assessed by participants’ accuracy in matching their heel position during the swing phase of walking to a virtual target presented on a monitor. Proprioceptive sense was assessed by knee joint position sense with a validated protocol using the Lokomat robotic exoskeleton. Subjects then underwent proprioceptive training. The training protocol required subjects to detect whether their heel position was higher or lower compared to an initial position. After each trial, visual feedback about their accuracy was provided. The assessments of skilled walking and knee joint position sense were assessed post-training as well as 24-hours later. Results and Conclusion: Our results showed that the training protocol was effective, with a significant improvement in knee joint position sense post-training that was also evident 24-hours later. A slight trend in improvement was also observed in skilled walking performance post-training. These findings indicate that it is possible to improve lower limb proprioceptive acuity following sensory training and that such improvements could further influence skilled walking performance.Education, Faculty ofKinesiology, School ofGraduat