Effects of external cues on gait performance in independent ambulatory incomplete spinal cord injury patients

Study design: An experimental, cross-sectional study. Objective: To investigate effects of external information or external cues on gait performance in independent ambulatory incomplete spinal cord injury (iSCI) patients (American Spinal Injury Association C or D, and functional independence measure walking scores 5-7). Setting: A university hospital, Thailand. Method: Gait performance was assessed in 29 patients with iSCI under four conditions including self-determined fastest walking speed, and fastest walking with the use of visual, auditory and visuotemporal cues. Average gait speed, stride length, cadence and percent step symmetry of these conditions were compared. Results: The use of external cues facilitated subjects to walk faster with a greater stride length, cadence and percent step symmetry than their own determination. The visuotemporal cue assisted subjects to increase their walking speed by 0.17 m s(-1). The visual cue helped subjects to walk with a significantly greater stride length than the self-determined fastest pace condition (P < 0.05). However, the visual cue made subjects walk with the lowest cadence and significantly lower than the visuotemporal cue condition (P < 0.05). Conclusion: External information helped subjects to reorganize movement characteristics and perform a more efficient spatiotemporal gait pattern. The findings imply a significant role of external information on gait performance in patients with iSCI. Spinal Cord (2009) 47, 668-673; doi:10.1038/sc.2008.168; published online 13 January 2009