Making the Brain Better at Walking

Exercise has many proven benefits. It can help control weight, reduce risk for heart disease and improve mood. Now, at Shepherd Center, Edelle Field-Fote, PT, Ph.D., FAPTA, director of spinal cord injury (SCI) research, along with exercise physiologist Nick Evans, MHS, ACSM-CEP, and the SCI research team are conducting a clinical trial to test how exercises focused on specific activities related to walking can best improve function for people with SCI.

Brains and brawn: how brain stimulation and task-related training may help people with SCI

While people are inpatients at Shepherd Center, they receive comprehensive care from a team of rehabilitation professionals. If the person has sustained an incomplete SCI and still has some movement in his/her legs, this care may include locomotor training to help improve and recover walking function and balance. Once a person finishes the rehabilitation program and returns home, it can understandably be difficult to continue the kind of training needed to maintain the gains made in therapy.

The SCI research team is analyzing a novel training approach that can be done in the home, which is intended to help people retain the gains they made during locomotor training after leaving Shepherd Center. The approach involves a circuit of six training activities, designed so that no special equipment is needed and focused specifically on the muscles that are important for walking. In the circuit, each of the six training activities are performed for one minute at a quick speed in order to increase heart rate. Activities that increase heart rate have been shown to improve the ability to learn a skill. Once all six circuit activities are completed, the circuit is repeated three more times.

The training activities are not the only novel part of the study. Participants in the clinical trial are randomly assigned to one of two groups. In addition to doing the circuit activities, half of the participants also receive brain stimulation called transcranial direct current stimulation (tDCS) where a continuous, low-intensity current is applied to the scalp over the area of the brain that controls movement in the leg muscles. The other group performs the same circuit activities, but without brain stimulation.

The brain areas controlling the muscles needed for walking are activated when a participant is performing the training activities regardless of whether or not the participant is receiving brain stimulation. The question that the SCI research team wants to answer is whether applying brain stimulation simultaneously with the training activities helps the brain become even better at controlling the muscles. The idea is that brain stimulation may make the brain better at sending information down the spinal cord so more information gets to the muscles, and this may improve walking function and balance even more than the training alone. Ultimately, the goal is that regardless of which group participants are in, the training activities will help retain or improve the gains they made during therapy at Shepherd Center.

Dr. Field-Fote hopes this approach proves to be effective so it can become part of standard rehabilitation practice.

“One of the hallmarks of Shepherd Center’s innovative research program is to focus on initiatives that are accessible, practical and founded in the latest science to improve function and quality of life,” said Dr. Field-Fote. “This particular study is the first of its kind to test whether a circuit of training activities without special equipment can help improve walking function. It is also the first to use a clinically available form of brain stimulation to improve walking function after an SCI.”

This clinical trial is funded by a federal grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) as part of the Spinal Cord Injury (SCI) Model Systems Program. Enrollment in the study is open through early 2021, at which point researchers will begin analyzing the data to determine the next phase of the research based on the results. If you would like to apply to participate in this or any of our studies for participants with SCI, click here to browse through the available options and contact the study coordinator of the study you are interested in for additional information.

Written by Damjana Alverson