Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Spinal Cord Injury
To determine 1) if a novel device, SLIP, creates a slip and balance reaction, 2) how well clinical measures correlate with performance ability on SLIP, and 3) within session change in balance ability.
SLIP consists of 6 boards, in series, which each can be set to a particular slip distance (0” - stable, 2”, 4”, 6”, 8”). Day 1: Determination of individual slip distance (ISD, 50% fall rate on SLIP) and clinical measurements (Functional Gait Assessment (FGA), Activities Specific Balance Confidence (ABC)), and force-plate balance) completed. Day 2: Force-plate balance assessment before/after 24 trials on SLIP with ISD.
Setting : Research Hospital
Participants (or Animals, Specimens, Cadavers) :
Consecutive sample.7 subjects with incomplete, chronic spinal cord injury capable of walking 30 feet without an assistive device, mean age 43.7 years. 3 cervical, 3 thoracic and 1 lumbar injury. No patients withdrew from adverse effects.
Interventions : One session on SLIP x24 passes with ISD
Main Outcome Measure(s) : Linear regressions with clinical measures and ISD. Center of Pressure Velocity (COPv).
Results : Significant high correlation (R2 = 0.72) seen between performance on SLIP and FGA versus low correlation on the ABC and SLIP (R2=0.10). Group mean COPv reduction of 8.5-8.8% in standing & Romberg positions between day 1 and 2, while COPv increased by 5.8% (Romberg) and 13.3% (standing) pre/post day 2 trial.
Conclusions : Score achieved on the FGA was a good predictor of how well an individual will perform on SLIP, but subjective balance confidence measured on the ABC was not. Improved balance stability was observed between day 1/2 pre-trial COPv, however fatigue appears to play a role post-trial day 2. SLIP device may be a novel and effective clinical tool to reduce slip related falls.
Kristen Hohl– Physical Therapist, Shirley Ryan Abilitylab, Chicago, Illinois
Ashir Bansal– Research Intern, Shirley Ryan Abilitylab, Chicago, Illinois
Chandrasekaran Jayaraman– Postdoctoral fellow, Shirley Ryan AbilityLab, Chicago, Illinois
Chandler Clark– Mechanical Engineer, Shirley Ryan Abilitylab, Chicago, Illinois
Jim Lipsey– Engineering Manager, Center for Bionic Medicine, Shirley Ryan Abilitylab, Chicago, Illinois
Levi Hargrove– Director, Center for Bionic Medicine, Shirley Ryan Abilitylab, Chicago, Illinois
Arun Jayaraman– Director Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan Abilitylab, Chicago, Illinois