A comparison of elbow and wrist kinematics and kinetics during swing-through versus reciprocal gait with crutches in persons with incomplete spinal cord injury

Study design Descriptive study with cross-sectional data collection. Objectives To analyse and compare the 3D kinematics and kinetics of thorax, elbow and wrist, and the spatio-temporal parameters during swing-through gait (SG) and reciprocal gait (RG). Setting Hospital Nacional de Parapléjicos in Toledo, Spain. Methods An instrumented biomechanical analysis of the upper body of 15 adults with an incomplete lumbar or thoracic spinal cord injury was performed using a marker motion capture system and load cell crutches. Five walks of each gait pattern were analysed. Results The elbow was in flexion, valgus and pronation and the wrist was in extension and ulnar deviation in both SG and RG. Their kinematic patterns were quite similar, except in elbow valgus and wrist extension in which statistically significant differences were observed. In the thorax prevailed flexion movement in SG and rotation movement in RG. The reaction forces in the elbow and the wrist were notably higher in SG than in RG, but the joint moments were similar in both gait patterns. Conclusions SG showed greater demands and RG showed higher requirements on trunk motor control. In addition, SG could increase the probability of back and neck pain. Therefore RG should be recommended, whenever possible, in incomplete spinal cord injured people. Rehabilitative management should consider adapting properly the crutch height and the inclination cane, loading the minimum weight on the crutches, using cushioning devices, reducing the duration of support phase, and limiting the overall use time of the crutches.