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TREADMILL TRAININGLaurance Johnston, Ph.D.Many aggressive rehabilitation programs haveincorporated body-weight-supported (BWS) treadmill training to enhanceambulatory ability after spinal cord injury. This training apparentlydevelops new function-restoring neuronal networks and triggers thespinal-cord’s “central-pattern generator,” a sort of brain within thespinal cord that can sustain lower-limb repetitive movement, such aswalking, independent of direct brain control.
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The article summarizesvarious research studies evaluating the impact of treadmill training.Because specific procedures often vary considerably, it is hard toover-generalize the results. Some studies suggest considerable benefits,and others do not.STUDIES:A key pioneer in developing treadmill training forSCI is Dr. Anton Wernig (Karlsbad, Germany), a scientist I’ve metwho seems to have almost a Zen-like appreciation of movement in thosewith SCI.In 1992, Wernig and colleagues reported the results of training eightindividuals with incomplete SCI with a variable speed treadmill, onwhich the individual was partially supported with a harness ( Paraplegia1992; 30(4)).To enhance correct ambulatory movements, therapistsassisted the subjects. With practice, support was reduced from 40% to0%.
Starting 5-20 months after injury, patients trained for 1.5-7 monthsfor five days a week, 30-60 minutes daily. All improved theirambulation, including the ability “to walk short distances, to beartheir body weight fully without knee-stabilizing braces and to climbstairs while needing only a handrail and one cane.”In 1995, the investigators reported the results ofa larger study evaluating such training in 44 patients with chronic SCI( Eur J Neuroscience 1995; 7(4)).
The patients had sustained theirinjuries ½ -18 years before initiating 3-20 weeks of training. Mostimproved their ambulation. Fourteen of 18 patients learned to walkwithout help from others compared to 1 of 14 of those who receivedconventional therapy.Follow-up assessments indicated that patients whohad improved to the point of walking independently continued to usetheir new found abilities over time as a part of every-day life.
Inaddition, after training, 36 of the 44 patients were capable of stairwalking compared to only six before. Of acutely injured patients, 92%who used wheelchairs became independent walkers after treadmill trainingcompared to only 50% after conventional therapy.Dr. (Hamilton, Ontario)studied the effects of long-term, BWS treadmill training in 14 subjects(11 men, 3 women) with chronic, incomplete SCI ( Spinal Cord 2005;43(5)). The time since injury ranged from 1.2 to 24 years. Subjectsexclusively trained on the treadmill three times a week for a total of144 sessions over a 12-15 month period. All subjects who completed theprogram improved their treadmill walking ability, including a 54%reduction in body-weight support, a 180% improvement in walking speed,and a 335% in the distance covered per session (from 221 to 961 meters).The improvements were associated with increasedlife satisfaction and physical function; and also improved muscle massand composition, and blood-lipid profiles and glucose-toleranceconsistent with a lowered risk of SCI-related diabetes andcardiovascular disease. Some improvements diminished over time assubjects discontinued training.
Although such training appeared toreverse post-injury muscle atrophy, it did not prevent bone loss. Theprogram did not include over ground walking. ( Spinal Cord 2005;43(11)).Dr.
Bruce Dobkin (Los Angeles, Calif) andassociates compared high-speed BWS treadmill training with a controlprogram of aggressive over-ground mobility training ( Neurology2006; 66(4)). Injured for fewer than eight weeks, 146 subjects wererecruited from six centers. Subjects were randomized to a 12-weektreadmill or control program (e.g., aided over-ground walking, etc.),both providing an hour of training per session for at least 45 sessionsover 12 weeks or until reaching a defined level of restored ambulation.The investigators were unable to detect differences in benefits accruingbetween the treadmill and control groups. In a later commentary, Wernignoted this outcome was to be expected due to equal amounts of uprightwalking.Dr.
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Marcus Wirz (Zurich, Switzerland) andcolleagues (U.S.A. And Germany) treated 20 subjects (18 men, 2 women)with incomplete, chronic injuries with BWS treadmill training using theLokomat, a robotic treadmill device that minimizes the need for assisting therapists ( Arch Phys MedRehabil 2005; 86). Thetime elapsing since injury and training ranged between 2-17 years, andparticipants’ age ranged from 16 to 64 years. Sixteen had someambulatory ability before training.The program consisted of three to five 45-minutesessions per week for eight weeks.
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Ambulatory ability was assessed by avariety of tests, most of which, - but not all - demonstratedimprovement. Subjects showed better gait speed, endurance, andperformance of functional tasks.Dr. Patricia Winchester et al.
(Dallas)examined the effects of 12 weeks of BWS treadmill training using theLokomat on the brain’s neuronal activity in four men with incompletecervical injuries ( Neurorehabil Neural Repair 2005; 19(4)).These subjects sustained their injuries 14 weeks to four years beforestarting the program and had sufficient range of motion to stand andsome ankle and toe movement.The study’s goal was to measure the differences inbrain neuronal activity before and after training - i.e., does treadmilltraining promote walking through brain reprogramming? To measure theintensity of walking-associated brain activity, subjects flexed theirankles and curled their toes while keeping their heads motionless withina MRI device. After 12 weeks, three of the four subjects demonstratedimproved walking, and all exhibited increased activity in brain areasassociated with walking.Drs.
Sarah Thomas and Monica Gorassini(Alberta, Canada) studied the effects of BWS treadmill training onbrain-to-muscle nerve transmission through spinal pathways inindividuals with chronic, incomplete injuries ( JNeurophysiol 2005; 94(4)). Little bombers returns game full version free download 2019. Age andtime since injury ranged from 29-78 years and 0.6-28 years,respectively.
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On average, the subjects trained for an hour five timesweekly for nearly 17 weeks.The capacity of these pathways to transmit nervesignals was measured by stimulating brain areas associated with specificleg muscles through a transcranial-magnetic-stimulation (TMS) deviceplaced over the scalp that activates descending neuronal pathways. Theamount of signal getting through to the leg muscles was then measured bya device in which electrodes are placed onthe skin over a muscle to detect electrical activity. Resultsindicated that the treadmill training improved ambulatory ability, whichwas associated with an increase in the transmission capacity betweenbrain and leg muscles.Miami Project’s Dr.
Edelle Field-Fote et al.evaluated the effects of BWS, FES-assisted (functional electricalstimulation) treadmill training on ambulation in 19 subjects withincomplete, chronic injuries ( Arch Phys Med Rehabil 2001; 82(6)).Training consisted of three-times-a-week, 1½ -hour sessions for threemonths. All subjects improved walking speed and lower extremitystrength.Later, the investigators reported the results of astudy in which 27 individuals with incomplete SCI were randomly assignedto the following groups: 1) treadmill training with manual assistance,2) treadmill training with FES stimulation, 3) over-ground training withFES stimulation, and 4) treadmill training using robotic assistance ( JNeurol Phys Ther 2005; 29(3)).