Laufband Therapy Based on‘Rules of Spinal Locomotion’is Effective in Spinal Cord Injured Persons

Abstract

Rehabilitation of locomotion in spinal cord (s.c.) injured patients is unsatisfactory. Here we report the effects of a novel 'Laufband (LB; treadmill) therapy' based on 'rules of spinal locomotion' derived from lower vertebrates. Eighty-nine incompletely paralysed (44 chronic and 45 acute) para- and tetraplegics underwent this therapy, then were compared with 64 patients (24 chronic and 40 acute) treated conventionally. The programme consisted of daily upright walking on a motor driven LB initially with body weight support (BWS) provided by a harness and assisted limb movements by the therapists when necessary. Forty-four chronic patients with different degrees of paralysis undertook the programme for 3-20 weeks (median = 10.5), 0.5-18 years after s.c. damage. At the onset of LB therapy 33/44 patients were wheelchair-bound (no standing and/or walking without help by others) whereas at the end of therapy 25 patients (76%) had learned to walk independently, 7 patients with help [corrected]. Only 1 subject did not improve. It was striking that voluntary muscle activity in the resting position was still low in several patients who had gained walking capability. Eleven patients who could already walk before LB therapy improved in speed and endurance. Of the 44 patients, six were capable of staircase walking before LB therapy compared with 34 afterwards. In order to validate the apparent superiority of LB therapy two types of comparisons were performed. In a 'temporal' control 12 spastic paretic patients, still wheelchair-bound after the period of postacute conventional therapy, performed LB immediately thereafter. After completion of LB therapy nine of these patients had learned to walk without help from others.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

“…Functional walking was assessed in two ways: (1) by measuring the walking speed, distance walked and %BWS provided during a typical treadmill session and (2) using a modified version of a scale developed by Wernig et al 3,7 to evaluate over ground walking abilities (see Table 2). …”

“…Studies in both the acute [1][2][3][4] and chronic 3,[5][6][7] SCI population have shown that functional walking ability can be improved with BWSTT in patients with motor-incomplete (American Spinal Injury Association Classification (ASIA) C or D) paraplegia or tetraplegia. These results are certainly encouraging, but a number of issues need to be resolved before BWSTT becomes accepted as a standard form of rehabilitation after SCI.…”

Maintenance of locomotor abilities following Laufband (treadmill) therapy in para- and tetraplegic persons: follow-up studies

“…In man after complete spinal transection, only elements of stepping but no full step cycles may be evoked on the treadmill. 5,6,12 Improvement of stepping in spinal cord injured cats and monkeys was achieved by intensive treadmill-stepping; 1,2 other training regimes such as daily standing were not successful and even signi®cantly worsened stepping capabilities in cats. 15,18 Translated into strategies for motor rehabilitation of spinal cord injured patients, these observations imply that relearning of walking can be done only by intensive exercise of upright walking.…”

Setting the stage for functional repair of spinal cord injuries: a cast of thousands

“…Treadmill training has been used with considerable success in people with SCI, classified as functionally incomplete, 352 that is, with retention of some sensory or motor function below the level of injury (ASIA scale B-D). Persons were selected if they had some voluntary activity in leg muscles, had mobile joints, had no spasticity and if they lacked complications such as ulceration or infection.…”

“…Follow-up studies in persons with incomplete injuries were encouraging and showed that improvements made during a few weeks to months of treadmill training were maintained for 6 months to 6 1/2 years after training ceased. 352,353 The long-term effects of treadmill training have recently been compared for individuals that are functionally incomplete and complete. 354 After training (15 min daily, 5 days per week for several months), persons with incomplete injuries showed significant improvements and could use their new locomotor capabilities for overground walking for at least short distances.…”