Role and Significance of Trunk and Upper Extremity Muscles in Walker-Assisted Paraplegic Gait: A Case Study

Background and Purpose: Understanding the role and significance of trunk and upper extremity muscles in paraplegic gait can help in designing more effective assistive devices for these patients and also provides valuable information for improving muscle strengthening programs. Methods: In a patient with a spinal cord injury (SCI) who could walk independently (rating scale of ambulatory capacity, 9) with the aid of bilateral ankle-foot orthosis and a walker, the kinematics, kinetics and electromyographic (EMG) activities of 16 muscles from the trunk and upper and lower extremities were recorded during gait. The onset, cessation, and duration of the EMG signal were associated with the 4 phases of each step, distinguished based on the kinematics results. Results: It was found that the reciprocating activation pattern of the quadratus lumborum, latissimus dorsi, pectoralis major, and lower trapezius is responsible for trunk extension during the balance adjustment phase, leg unload and foot clearance creation during the leg raising phase, and propulsion force generation during the leg swing phase. Conclusion: The continuous activation of the rectus abdominis and erector spinae within the gait cycle helps stabilize the thorax and acts in reverse, that is, fixes the proximal joint and moves the distal limb. The shoulder girdle muscles contribute to the leg's unloading and then smooth landing during leg raising and leg swing phases, respectively.