An NLOI below T11 is associated with an increased potential for ambulation

An nloi below t11 is associated with an increased

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An NLOI below T11 is associated with an increased potential for ambulation. Important considerations in whether an individual can achieve community ambulation are the presence of functional hip flexion (to advance the hip) and knee extension (to avoid buckling at the knees), which begin at the L2 and L3 neurologic levels, respectively. Orthotic assistance with KAFOs and/or AFOs, along with a walker or crutches, may be necessary. In individuals with incomplete spinal cord injury (SCI), intensive overground mobility therapy and body- weight–supported treadmill training (BWSTT) are accepted standards of care in gait rehabilitation. [15, 16] Manual BWSTT can be labor intensive for the therapy team (involving multiple therapists and time). Robotic-assisted gait training (eg, Lokomat system) is being used more commonly in formal SCI therapy, in order to optimize the body’s rhythmic generations of stepping movements. [17] Most often, successful brace-assisted community ambulation is accomplished by individuals with an injury at or below the L3 level. Success also depends on factors such as intact hip and knee proprioception, an ability to tolerate the high-energy requirements of such ambulation, the patient's motivation and age, his/her cardiopulmonary stability, the severity of spasticity, the presence of joint contractures (especially of the hips, knees, and ankles), and the presence of pain. Several orthotic options and assistive devices are available; these vary according to the level and degree of muscle weakness. In addition, FES can be used in patients with injuries at even higher levels than this to achieve community ambulation. Neuroprostheses Neuroprostheses are devices that use electrodes to interface with the nervous system to restore function. They hold great potential, and, although there are few commercially available devices, they represent an area of emerging technology. [18] There are functional electrical stimulation (FES) devices that can be used for both upper and lower extremities, diaphragm, and bladder. Patients work closely with therapists at first, but then can transition to using the device at home on a regular basis. FES can help reduce disability and improve function and quality of life, if used on a consistent basis. Lower extremity neuroprostheses can be used to provide mobility in individuals with low cervical or thoracic spinal cord injury (SCI). These devices can give a patient capabilities, such as standing, performing transfers, and walking, that were previously unobtainable with injuries at these levels. The Parastep device one of the commercially available, portable FES system in which surface electrodes are placed over the quadriceps, peroneal nerve, and gluteal muscles to stimulate movement and allow
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9/13/2017 Functional Outcomes per Level of Spinal Cord Injury: Overview, Neurologic Level and Completeness of Injury, C1-C4 Tetraplegia (High Tetraple… 8/13 the person to stand and walk. Use of this device is usually indicated for individuals with a T4-T12 neurologic level of injury. Factors limiting its use may include upper extremity strength, lower extremity
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  • Spring '08
  • Herzog,A

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