Gait analysis methods in people with spinal cord injury: a systematic review.

BACKGROUND

Spinal cord injury (SCI) leads to impairments in motor, sensory, and autonomic pathways, often resulting in significant disability and reduced quality of life. Recovery of ambulation is a priority for people with SCI and vital for regaining independence and social participation. The increasing incidence of incomplete SCI, especially from non-traumatic causes like degenerative cervical myelopathy, has amplified the clinical relevance of gait recovery. Although gait analysis is widely applied in neurological conditions, its use in people with SCI remains limited, and there is no consensus on standardized protocols or essential methods. This systematic review aimed to identify and summarize the instrumentation and measures used in gait analysis of people with SCI. MATERIALS AND

METHODS

The review protocol was registered with PROSPERO (CRD42024520587). Electronic databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched up to May 1, 2025. Inclusion criteria focused on studies involving adult people with SCI capable of walking with or without aids, using computer-based gait analysis tools. Selected studies were analyzed for methodological quality, level of evidence (LoE), types of gait measures assessed, and instrumentation used.

RESULTS

We included 48 studies. Over half of studies were fair quality (54%), while LoE was 2 in nearly half of studies (48%). Spatio-temporal measures were most frequently assessed (255 recordings), particularly gait speed (35 studies), cadence (26), step length (24), stride length (23), and step width (20). Kinematic measures were recorded 108 times, surface electromyographic (sEMG) measures 63 times, and kinetic measures 21 times. Three-dimensional motion capture systems dominated instrumentation (30 studies), followed by sEMG (12), force platforms (11), instrumented walkways (10) and inertial measurement units (8).

CONCLUSION

This review highlights a strong preference for spatio-temporal and kinematic measures due to their clinical relevance, ease of interpretation, and alignment with rehabilitation goals in SCI. Despite their value, kinetic and sEMG measures were underused, likely due to complexity, limited standardization and barriers to clinical implementation. The findings underscore the need for standardized protocols and broader clinical integration of gait analysis to optimize functional outcomes, and our systematic review provides a basis for future research and clinical applications in people with SCI.