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C - Walking

Figure 3.0 Advanced Gait Skils Training and Customi zed FES Approaches 0 2 4 6 8 10 12 Number of Sites Current Canadian Practice: Understanding the Assessment and Recovery of Walking Ability aligned with clinical rehabilitation programs (GF Strong, Toronto Rehab, Jewish Rehabilitation Hospital, the Institut de Réadaptation Gingras- Lindsay-de-Montréal and the Institut de réadaptation en déficience physique de Québec) where therapists and scientists often interact regarding best practices in gait training. Site Research and Development Leads GFSRC Cardiovascular Capacity for Walking ICORD Lokomat Assisted Training CARRE Motor Cortical Enhancement Overground Training Paradigms Community Walking Measurement - SCI-FAP TRI-UHN Functional Electrical Stimulation Walking Measures Battery for Outcomes GAITRite Asessment for Symmetry Transcranial Magnetic Stimulation Biomechanical Analysis of Gait Virtual Reality Paradigms for Training Body Weight Support Treadmill Training IRDPQ Orthotic Applications Sensorimotor Stimulation Walking Research Site Stairs Uneven Terrain Obstacles Community Environments FES Assisted-Ankle Dorsiflexion FES Assisted-Knee Extension FES Assisted-Ankle Eversion FES Assisted-Hip Abducon FES Assisted-Hip Flexion FES Assisted-Upper Extremity IRGLM JRH TRI-UHN CHPR Advanced gait-training approaches are in place in all sites (Figure 3.0). However, only 50% of the programs train for walking in community environments. This practice needs to be addressed, as community ambulation is a priority for individuals with SCI and a benchmark for some programs. There is almost no customization of FES for specific muscle groups to facilitate walking. It is important to know whether this is an equipment, practice or practitioner issue. There are no reports of the use of whole-body vibration as an approach for improving walking function (inter-limb coordination, speed and cadence) as has been demonstrated by Ness and Field-Fote.4 Nor was there mention of having the equipment in the clinical setting, with the exception of Lyndhurst Centre where it is being used in phase two research studies. Much of what we know globally about walking ability, post-SCI, has come from the researchers in the academic health science centres in Canada (University of British Columbia, Simon Fraser University, University of Alberta, University of Toronto, McMaster University, Unversity of Montréal, McGill Univerity, and Laval University), spearheaded kinesiologists (Figure 4.0). These research programs, initiated in the early 1980s by Barbeau, have continued to flourish and have now gained international recognition. Most of the research programs are now Figure 4.0 These sites are forging ahead with new research on asesment and interventions adresing walking ability and capacit y, in both sub-acute and chronic SCI populations . ICORD GFSRC IRDPQ IRGLM by MSc/PhD-trained neuroscientists, physical therapists and CARRE JRH 0 150 300 600 km Facility City Province GF Strong Rehabilita‚on Centre Interna‚onal Collabora‚on on Repair Discoveries Centre for Ambulatory Rehabilita‚on Research and Educa‚on Centre for Health Promo‚on and Rehabilita‚on Toronto Rehabilita‚on Ins‚tute - UHN Lyndhurst Centre Jewish Rehabilita‚on Hospital Ins‚tut de rédaption Gingras-Lindsay de Montréal Institut de rédaption en dé cience physique de Québec GFSRC Vancouver BC ICORD Vancouver BC CARRE Edmonton AB CHPR Hamilton ON TRI-UHN Toronto ON JRH Montréal QC IRGLM Montréal QC IRDPQ Québec QC Janice Eng Tania Lam Monica Grossini Jaynie Yang Kristen Musselman Milos Popovic Molly Verrier Kristina Guy Dorothy Barthelemy Sylvie Nadeau Joyce Fung Hugues Barbeau Laurent Bouyer Carol Richards WALKING | BODY STRUCTURE AND FNUCTION 49


C - Walking
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