By Gurpreet Dhanda
This is a summary of a paper published by a group of researchers in the Department of Experimental Medicine in Vancouver, British Columbia, in the Spinal Cord.
Original Article: Spasticity changes in SCI following a dynamic standing program using the Segway. Boutilier G, Sawatzky BJ, Grant C, Wiefelspuett S, Finlayson H. Spinal Cord. 2012 Aug;50(8):595-8. doi: 10.1038/sc.2012.23. Epub 2012 May 15.
What’s new in SCI research?
The majority of individuals affected by SCI also suffer from spasticity. Spasticity, meaning increased reflex activity, results when there is a loss of the signals descending from the brain to create proper movements. This often means pain and fatigue in daily activities, leading to a reduction in quality of life. A recently published study by ICORD researcher Dr. Bonnie Sawatsky set out to determine if a “dynamic standing” program using the Segway Personal Transporter could alleviate symptoms of spasticity. The researchers noted that able-bodied individuals are capable of reducing any loss of control from the brain during walking. They hypothesized that similar results might be obtained for sufferers of spasticity using the Segway. This latest research provides greater insight into the potential benefits of using the Segway: using the transporter in conjunction with a dynamic standing program provided an immediate reduction in spasticity as well as a drastic decrease in pain for every participant.
What was the most important finding?
This study presented a promising foundation for developing the Segway as a tool to reduce or eliminate spasticity, pain and fatigue in the SCI community. It also demonstrated the benefits of incorporating the personal transporter with a dynamic stability program. The researchers reported a favourable attitude towards dynamic stability training when it was done on the Segway, in contrast to passive stretching with standing frames. Ultimately, this study suggested that developing dynamic stability in this way may provide the potential to enhance intact signalling pathways in SCI individuals. It also described a possible path to calm the spinal reflex pathways involved in spasticity.
What are some things we need to consider?
As noted by the authors of the paper, there are several points to take into consideration. The study itself was essentially descriptive, due to its preliminary nature and relatively small sample size, and there was no uninjured control group included. Ultimately, the findings describing ratings of fatigue, spasticity impact and muscle scores did not demonstrate a statistically significant difference in outcome before and after the intervention. The researchers also noted the Segway is relatively expensive and requires some degree of motor ability to operate. As such, this device will not be appropriate for all members of the SCI community.
What does this mean for people with SCI?
Ultimately, this study means that individuals with SCI may find a reduction in spasticity-related pain by using the Segway. This effect is similar to that created by the alternating rhythmic movement of walking. By making use of the dynamic stability required on a Segway, people with SCI may in fact override the hyperactive reflex that initially promotes spasms. Through engaging muscle groups in dynamic movement, individuals with SCI may promote positive changes to the spinal circuits responsible for spasms. In time, repeated stimulation of these circuits could lower the excitability of the reflex pathways responsible for chronic spasticity in individuals with SCI.