Postural control during gait initiation and termination of adults with incomplete spinal cord injury

Gait initiation and termination are potentially challenging tasks for balance due to the transition from a quasi-static bipedal phase to a dynamic single-support phase. The purpose of this study was to compare the bipedal and single-support phases of gait initiation and termination in individuals with incomplete spinal cord injury (ISCI). Twelve individuals with ISCI were evaluated on the dynamic and postural components of balance using the stabilizing and destabilizing forces during gait initiation, termination and natural gait. Phase comparisons were made using non parametric tests. Visual inspection of the force profile of the factors explaining the forces was also conducted. Gait termination challenged more the postural control during the single-support phase than the bipedal phase for the dynamic component of the stabilizing/destabilizing forces model (p=.002). For gait initiation, the most challenging phase varied with the components analyzed (single-support phase for the dynamic component, bipedal phase for the postural component) (p⩽.008). The single support phase is more challenged during gait termination (both components) (p⩽.015) while the bipedal phase is more challenged during gait initiation (dynamic components) (p=.012). The stabilizing force and the speed of the center of mass on the one hand, and destabilizing force and the distance between the center of pressure and the base of support on the other hand, had a similar profile. The single-support phase of gait termination was the most challenging among all phases evaluated, being as challenging as the single-support phase of level natural gait. This phase should be targeted in rehabilitation in order to improve balance and decrease the risk of falling in this population.