Description and application of a system for locomotor rehabilitation

Barbeau, Hugues; Wainberg, Michael; Finch, Lois

doi:10.1007/bf02447435

Cited by 204 publications

(83 citation statements)

References 5 publications

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“…For example, several laboratories have developed a new strategy for the rehabilitation of lower limb function after spinal cord injury using a partial body weight support harness to facilitate ambulation. Edgerton and colleagues 67,68 and Barbeau and colleagues 69,70 explicitly derived their therapeutic regimen for human spinal cord injury from their own early work in animals 71,72 . Using a similar methodology, other investigators (for example, Wernig and Müller 73 in people with spinal injury, and Hesse et al 41 in people with stroke) have also relied on basic research in animals in the formulation of their therapeutic procedures.…”

Section: Other Therapies Emerging From Basic Researchmentioning

confidence: 99%

New treatments in neurorehabiliation founded on basic research

2002

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The relative dearth of effective interventions in neurorehabilitation could be partly attributable to the weak contribution that this field has received from basic sciences such as neuroscience and behavioural psychology. Neuroscience holds an important place in the curriculum of physical therapy schools, but its influence has been largely didactic and has had little bearing on clinical practice. Behavioural psychology has contributed much to the treatment of chronic pain 1 , but has little or no place in the curriculum of physical rehabilitation schools or in the development of treatments for movement disorders. In other health-related fields, basic research has, of course, been of inestimable value in enabling the development of new therapeutic interventions. In the neurosciences, the fruitfulness of this approach has been amply shown by the development of treatments for Parkinson's disease and other disorders on the basis of the pioneering work of Carlsson and others on chemical neurotransmission 2,3 . The paradigm shift that is mentioned in the preface refers to the fact that this process of translation of basic research into new treatments is beginning to take place in the field of neurorehabilitation and is proceeding at an accelerating pace.After injury to the central nervous system (CNS), the initial deficit in behaviour, perception and/or cognitive ability is frequently followed by a spontaneous recovery of function. This resiliency may be considered as one type of behavioural plasticity. By apparent contrast, the traditional view in neuroscience during the first threequarters of the last century was that the mature CNS has little capacity to reorganize and repair itself in response to injury. This view extends back into the nineteenth century, promoted initially by Broca's studies on the localization of function within the brain 4 , which emphasized the constancy of organization of the mature CNS even after substantial injury. Although contrary views were expressed 5,6 , the mature CNS was generally believed 7 to show little or no plasticity 8 . Hughlings Jackson's hierarchical view 9 that lower centres of the brain substituted in function for higher damaged centres after CNS insult, together with other related formulations, had an important influence for most of the twentieth century on our thinking about the recovery of function. However, the phenomenon of spontaneous recovery of function was never fully explained and received little experimental attention, largely because the techniques needed to explore this process had not yet been developed. Beginning in the 1970s, research from several laboratories, including those of Merzenich Recent discoveries about how the central nervous system responds to injury and how patients reacquire lost behaviours by training have yielded promising new therapies for neurorehabilitation. Until recently, this field had been largely static, but the current melding of basic behavioural science with neuroscience promises entirely new approaches to improving behavioural, ...

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Section: Other Therapies Emerging From Basic Researchmentioning

confidence: 99%

New treatments in neurorehabiliation founded on basic research

2002

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“…Following the first description of a viable clinical system in 1987, 1 goal-oriented treadmill training with partial body weight support (BWS) has evolved as a promising treatment option in spinal cord-injured (SCI) subjects. Several open clinical studies showed successful gait restoration in para-and tetraparetic subjects.…”

Section: Introductionmentioning

confidence: 99%

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Hesse¹,

Werner²,

Bardeleben³

2004

Spinal Cord

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Study design: Single case studies. Objectives: To describe the technique of intensive locomotor training on an electromechanical gait trainer (GT) combined with functional electrical stimulation (FES). Setting: Neurological Rehabilitation Clinic, Berlin, Germany. Methods: Four spinal cord-injured (SCI) patients, one tetraparetic, two paraparetic, and one patient with an incomplete cauda syndrome, more than 3 months postinjury, who were unable to walk at all, or with two therapists. They received 25 min of locomotor training on the GT plus FES daily for 5 weeks in addition to the regular therapy. Results: The patients tolerated the programme well, and therapists rated the programme less strenuous compared to manually assisted treadmill training. Gait ability improved in all four patients; three patients could walk independently on the floor with the help of technical aids, and one required the help of one therapist after therapy; gait speed and endurance more than doubled, and the gastrocnemius activity increased in the patients with a central paresis. Conclusion: This combined technique allows intensive locomotor therapy in SCI subjects with reduced effort from the therapists. The patients' improved walking ability confirmed the potential of locomotor therapy in SCI subjects.

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“…We can indirectly study the effect of peripheral feedback mechanisms with the interneuronal networks during locomotion by recording electromyographic (EMG) activity [29;101] from the leg muscles during manually assisted stepping using body weight support on a treadmill [11] in individuals with clinically complete spinal cord injury [28;66]. In these individuals the motor patterns observed during stepping are driven by the sensory information available to the interneuronal networks of the spinal cord and are dependent on the current physiological state of the central nervous system [13;32;33;46;68].…”

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confidence: 99%

Plasticity of interneuronal networks of the functionally isolated human spinal cord

Harkema

2008

Brain Research Reviews

149

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The loss of walking after human spinal cord injury has been attributed to the dominance of supraspinal over spinal mechanisms. The evidence for central pattern generation in humans is limited due to the inability to conclusively isolate the circuitry from descending and afferent input. However, studying individuals following spinal cord injury with no detectable influence on spinal networks from supraspinal centers can provide insight to their interaction with afferent input. The focus of this article is on the interaction of sensory input with human spinal networks in the generation of locomotor patterns. The functionally isolated human spinal cord has the capacity to generate locomotor patterns with appropriate afferent input. Locomotor Training is a rehabilitative strategy that has evolved from animal and humans studies focused on the neural plasticity of the spinal cord and has been successful for many people with acute and chronic incomplete spinal cord injury. However, even those individuals with clinically complete spinal cord injury that generate appropriate locomotor patterns during stepping with assistance on a treadmill with body weight support cannot sustain overground walking. This suggests that although a significant control of locomotion can occur at the level of spinal interneuronal networks the level of sustainable excitability of these circuits is still compromised. Future studies should focus on approaches to increase the central state of excitability and may include neural repair strategies, pharmacological interventions or epidural stimulation in combination with Locomotor Training. Capacity of functionally isolated human spinal cord to generate locomotor patternsThe loss of standing and walking after human spinal cord injury has been attributed to the dominance of supraspinal over spinal mechanisms in the control of locomotion in primates [34;57;84;106]. The evidence for central pattern generation in humans is limited due to the inability to conclusively isolate the circuitry from descending and afferent input [17-19;21; 41;60;68]. In studying the role of the human spinal cord in the generation of locomotor patterns we are restricted not only by our capacity to eliminate afferent input but also the ability to provide drugs or electrical stimulation directly to the spinal cord to activate the networks [10;62]. However, studying individuals following spinal cord injury with no detectable Susan Harkema, PhD, Frazier Rehab Institute, 220 Abraham Flexner Way, Louisville, KY 40202, susan.harkema@jhsmh.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal p...

show abstract

Description and application of a system for locomotor rehabilitation

Cited by 204 publications

References 5 publications

New treatments in neurorehabiliation founded on basic research

New treatments in neurorehabiliation founded on basic research

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Plasticity of interneuronal networks of the functionally isolated human spinal cord

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