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    #16
    sorry if i confused this issue, to be honest , i had never heard of an elliptical trainer before i found CC and never knew that motorised versions were available until reading this thread . my question was aimed at trying to obtain more information . to reverse ''learned non use '' and stimulate ''central pattern generators '' is mechanized input enough , or does there come a stage when input from the person's muscles are required ? i was also thinking of my own experience , i walk without swinging my arms [ along with other gait faults ] , and feel this [arm motion] is an important part of gait .

    thank you ,
    dogger

    every day i wake up is a good one .
    Every day I wake up is a good one .

    Comment


      #17
      Yes, Dogger

      Many of the locomotion people are indeed entraining quadripedal locomotion rather than bipedal locomotion. You might try doing a search on reciprocal reflexes and quadripedal reflexes. I believe that L2 stimulation will be very important for your locomotor training.

      Have fun,

      Janet [img]/forum/images/smilies/smile.gif[/img]

      Comment


        #18
        Dogger,

        I believe the mechanized arm swing would be enough...you will still be using your arm swing muscles. The mechanized arm swing will guide you threw the proper arm swing for you locomotor training. I hope that answers your questions.

        Good night,

        Janet[img]/forum/images/smilies/smile.gif[/img]

        Comment


          #19
          Piela, Janet,

          Who made you the resident expert?

          Do you even have a home based setup as I described?

          Have you personally ever tried or engaged in a harnessed elliptical training session?

          I don't buy it Janet. I think you're shooting from the hip and not giving realistic, practical advice.


          Dogger,

          yes, this idea is designed to reduce learned non-use and induce central pattern gait training. Motorized or not the idea is to practice walking for those who cannot normally.

          Additionally, the motor can increase / decrease speed which I believe is very interesting. The faster I go the more "natural" the motion and it feels like my body is re-learning at a faster rate (hard to describe).

          Obviously, if muscle innervation is present then hopefully one could "walk" without the motor turned on. Make sense?

          As far as arm swing I really don't think it matters in / on this apparatus - at least not initially or in my case.

          Hopefully this clarifies. Good luck.

          Comment


            #20
            ChrisD,

            When you're on the elliptical trainer, do you try reverse motion? (peddling backwards?)

            Do you think it would be a benefit to reverse motion from time to time?

            The reason I'm asking is it seems the muscles are quick to tire when peddling backwards.(working different muscles?)

            I wasn't very popular when I made the kids do backwards skating drills during hockey practices. (Legs get the "burn" very quickly.)

            Thanks. lway

            Comment


              #21
              Originally posted by Chris D:

              Piela, Janet,
              Who made you the resident expert?
              Did I ever say I was the resident expert Chris D?

              Originally posted by Chris D:
              Do you even have a home based setup as I described?
              Yes and much better than the one you described. Thanks.

              Originally posted by Chris D:
              Have you personally ever tried or engaged in a harnessed elliptical training session?
              Yes

              Originally posted by Chris D:
              I don't buy it Janet. I think you're shooting from the hip and not giving realistic, practical advice.
              Really... Do you think Dr. Young is shooting from the hip also and not giving realistic, practical advice also?

              Originally posted by Wise Young:
              • Dietz V (2002). Do human bipeds use quadrupedal coordination? Trends Neurosci. 25 (9): 462. Summary: Tackling the question of whether control of human gait is based on that of a quadrupedal locomotion system is of basic and practical relevance. During evolution, the increased influence of a direct cortical-motoneuronal system in parallel with more specialized hand function might have replaced phylogenetically older systems that organized locomotor movements. However, recent research indicates that interlimb coordination during human locomotion is organized in a similar way to that in the cat. Hence, it is hypothesized that during locomotion, corticospinal excitation of upper limb motoneurons is mediated indirectly, via propriospinal neurons in the cervical spinal cord. This allows a task-dependent neuronal linkage of cervical and thoraco-lumbar propriospinal circuits controlling leg and arm movements during human locomotor activities. The persistence of such movement control has consequences for rehabilitation and the applicability of animal research to human patients with spinal cord injury. ParaCare, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstr 340, 8008, Zurich, Switzerland.

              Originally posted by Wise Young:

              Arturo, great point. This is a subject of some discussion at the meetings that I have been to in the past 6 months. Many of the locomotion people are indeed thinking about entraining quadripedal locomotion rather than bipedal locomotion. The hierarchy of reflex activation, according to Sir Charles Sherrington (http://www.nobel.se/medicine/laureat...ton-bio.html), goes in the following order:
              1. Stretch reflex. This is where stretching of a muscle causes sensory input into the spinal cord that causes the muscle to contract. This monosynaptic reflex is mediated by spindle receptors that maintain the position of muscles.
              2. Extension reflex. This is when the leg is extended so that the quadriceps activation is associated with gastrocnemius. This is what allows you to stand.
              3. Flexion reflex. This is where a cutaneous stimulus causes the arm or leg to go into flexion. This is the classic withdrawal reflex. Unlike the stretch reflex, this involves multiple muscles on one side.
              3. Cross extensor reflex. This is when a flexion reflex occurs on one side, the contralateral side goes into extension. This is what allows you to balance with your other when one leg is flexed.
              4. Reciprocal reflexes. This is of course when the legs are stepping alternatively with swing-stance modes.
              5. Quadripedal reflexes. This is where the arm swing comes in and the forelimb movements are coordinated with the legs.
              6. Brainstem-spinal reflexes. Many of the reflexes require some brainstem involvement. For example, when you brush the dorsal surface of a rat's foot, it will make a stepping motion (like you would stepping over a tree branch).

              Most of the locomotor functions are coordinated through a network of neurons situated in the L2 spinal cord, sometimes called the central pattern generator. The CPG coordinates the left and right sides, as well as multiple segments, of the spinal cord. Although the CPG have been demonstrated in most vertebrate animals, the location and function of the CPG in humans was controversial until recently. Hermann and Dimitrijevic separtely showed that this center at the L2 spinal cord not only can initiate locomotion but will recruit many of the muscles that are not under direct voluntary control, thereby greatly improving the efficiency and coordination of locomotor function. I believe that L2 stimulation will be a very important part of locomotor training.

              Wise.
              Originally posted by Dr. Anton Wernig:

              Interesting! Most of the locomotor functions are coordinated through a network of neurons situated in the L2 spinal cord, sometimes called the central pattern generator. The CPG coordinates the left and right sides, as well as multiple segments, of the spinal cord. Although the CPG have been demonstrated in most vertebrate animals, the location and function of the CPG in humans was controversial until recently. Hermann and Dimitrijevic separtely showed that this center at the L2 spinal cord not only can initiate locomotion but will recruit many of the muscles that are not under direct voluntary control, thereby greatly improving the efficiency and coordination of locomotor function. I believe that L2 stimulation will be a very important part of locomotor training.
              Originally posted by Dr. Anton Wernig:
              I like the possibility for arm swing; in fact I have been thinking along precisely these lines and wanted to suggest to Woodway comp. To build such a device; but the company seems to have financial or other troubles right now. Anyway, I would hope that we could help severely paralysed tetraplegics a little bit this way.
              [/QUOTE]

              Originally posted by Wise Young:
              Wernig in Bonn Germany reported nearly 10 years ago that intensive locomotor training on a treadmill (laufband) can restore independent locomotion in as many as 40% of patients who have never walked after injury and as long as 10 years after injury. This was greeted with skepticism by many rehabilitation doctors in the beginning but the data now being collected both in Europe and the U.S. in NIH-funded and other clinical trials suggest that such training can restore function. The rationale is that neuronal circuits turn off when they are not used for long periods of time. I don't think that it is necessarily "new" circuits as much as waking up dormant circuits. In the old days, when everybody was discouraged from trying to walk, even when they are "incomplete", learned non-use was probably much more frequent than it is today. In Europe, there are rehabilitations centers that are beginning the locomotor training within weeks after spinal cord injury, in an effort to prevent learned non-use. Several questions have yet to be answered. How much and what is the best form of exercise? If 4-6 hours per day necessary? Is it really only for people with "incomplete" injuries. Those studies are going on right now and I think that the answer will be that intensive exercising will be necessary, that supported ambulation is not the only way, and that people with "complete" spinal cord injury will also benefit from the exercise even if they do not regain independent locomotion. Finally, I don't think that this is snake oil and it does suggest a new approach towards restoration of the function to many people with chronic spinal cord injury.

              • Wernig A and Muller S (1992). Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries. Paraplegia. 30 (4): 229-38. Summary: After low transection of the spinal cord mammalian quadrupeds can be trained to walk on a driven surface indicating that coordinating neuronal circuits persist in the spinal cord segments caudal to the lesion. We trained 8 persons with incomplete spinal cord lesion on a Laufband (driven treadmill) for 1 1/2 to 7 months (5 days a week, 30-60 minutes daily) starting 5 to 20 months after injury and found significant improvement in the utilisation of the paralysed limbs during locomotion. Locomotion is described in one additional patient who had trained independently on parallel bars for several years. Five patients had complete functional paralysis in one lower limb when tested in a resting position. In EMG recordings voluntary activity (ie activity induced upon command) was absent or residual in the main flexor and extensor muscles of this limb. In contrast, during locomotion flexion and extension movements were performed and phasic EMG activity was present. In these 5 patients, and in all others reported here, skin sensibility and proprioception are preserved to different degrees in all limbs. In the course of locomotive training of 4 severely paralysed patients the initially habituating flexion reflexes could be entrained in the paralysed limbs as was the case for knee extension during stance. Subsequently, initial body weight support (BWS) of 40% could be reduced to 0%. The distance covered on the Laufband (0-104 m in the first week) increased significantly (200-410 m) in the last week of training as did speed (0-10 to 14-23 m/min). More importantly, this training subsequently allowed patients to walk on a static surface for 100 to 200 meters while voluntary activity remained absent in the paralysed limb when tested at rest. Similar progress was achieved in the 4 less severely paralysed patients. The one patient who had trained independently on parallel bars for several years is described walking on a static surface for 40 meters with the help of a walker, though he had one completely and one near completely paralysed lower limb. It appears that bipedal stepping with consequent knee extension and stabilisation can be taught after unilateral complete or near complete loss of voluntary activity, suggesting the manifestation of complex reflex motor patterns at the spinal level. Department of Physiology, University of Bonn, FRG.
              • Wernig A, Muller S, Nanassy A and Cagol E (1995). Laufband therapy based on 'rules of spinal locomotion' is effective in spinal cord injured persons. Eur J Neurosci. 7 (4): 823-9. Summary: 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). Department of Physiology, University of Bonn, Germany.
              • Wernig A, Nanassy A and Muller S (1998). Maintenance of locomotor abilities following Laufband (treadmill) therapy in para- and tetraplegic persons: follow-up studies. Spinal Cord. 36 (11): 744-9. Summary: Recent reports indicate that walking capabilities in spinal cord damaged persons significantly improve--as compared to conventional rehabilitation therapy--after intensive training of aided (Laufband) treadmill-stepping. In the present report, follow up investigations on two collectives of spinal cord injured (sci) persons are described who had undergone (Laufband) treadmill therapy either during a period of renewed rehabilitation months or years after spinal cord injury (35 chronic patients) or during their first postacute rehabilitation period (41 acute patients). Among the initially chronic patients, 20 from 25 still wheelchair-bound before the onset of (Laufband) treadmill therapy, ie not capable of raising from the wheelchair and walking without help by other persons, became independent walkers after therapy. Assessment of voluntary muscle activity in resting position before and after the period of therapy had shown only small increases in most patients, indicating the involvement of motor automatisms and better utilisation of remaining muscle function during walking. Follow-up assessments performed 6 months to 6 1/2 years after discharge from the hospital revealed that the walking capabilities achieved by (Laufband) treadmill therapy in the 35 initially chronic patients were maintained in 31 persons, in three they had further improved, in only one it was reduced. These results indicate that the improvements achieved under clinical conditions can be maintained in every day life under domestic surroundings. From 41 initially acute patients, 15 had further improved and none had reduced his walking capability 6 months to 6 years after discharge from the hospital. Department of Physiology, University of Bonn, Germany.
              • Wernig A, Nanassy A and Muller S (1999). Laufband (treadmill) therapy in incomplete paraplegia and tetraplegia. J Neurotrauma. 16 (8): 719-26. Summary: Recent reports indicate that intensive training of upright walking on a treadmill (German: Laufband, LB), significantly improves walking capability in spinal cord-damaged persons. The aids provided initially are body weight support by a harness and passive setting of one or both limbs by therapists. To facilitate stepping and evoke motor automatisms, "rules of spinal locomotion" need to be applied during training. The effects of this novel locomotion therapy on patients with chronic and acute incomplete paralysis are summarized and discussed here. Many patients with chronic paralysis, still wheelchair-bound and not capable of walking without help from others, became independent and learned to walk for some distance without help. Assessment of voluntary muscle activity in resting position before and after the period of therapy often showed only small increases, rendering the involvement of complex motor reflexes (motor programs) and better utilization of remaining muscle function during walking as main sources for the improvements in locomotion. This idea is supported by electromyographic recordings. Follow-up assessments performed 0.5 to 6.5 years after discharge from the hospital show that the significant improvements achieved by LB-therapy in patients with initially chronic paralysis can be maintained under domestic surrounding. Patients with initially acute paralysis improved their walking capabilities even further. It is suggested that LB therapy may be generally applied in the motor rehabilitation of persons with acute and chronic incomplete paraplegia and tetraplegia. Its use in other diseases is discussed. Department of Physiology, University of Bonn, Germany. wernig@physio.uni-bonn.de.
              • Wernig A, Nanassy A and Muller S (2000). Laufband (LB) therapy in spinal cord lesioned persons. Prog Brain Res. 128: 89-97. Summary: Department of Physiology, University of Bonn, Germany. wernig@physio.uni-bonn.de.

              HapticWalker: New possibilities for gait training
              One major disadvantage of treadmill training and also the mechanised gait trainer is the limited variability of different gait parameters and possible training trajectories. On a treadmill the patient can only train walking on plane ground. In contrast the HapticWalker is freely programmable and allows the composition and training of any desired walking trajectory, i.e. walking on plane ground, stepping staircases up/down or other real world walking situations.
              From the medical point of view it is desirable to let the patient train as many walking situations as possible, he will be confronted with in the real world outside the rehabilitation clinic. Therefore the HapticWalker dynamics not only allow the training of relatively smooth walking trajectories with low dynamics, but also enable training of real walking situations, e.g. walking on rough surfaces or stumbling.
              Haptic biofeedback is also a very important issue: The machine can be switched in from full foot guidance (position control) to haptic device behavior (impedance control), where only virtual ground conditions are simulated. In haptic mode the machine behaves purely passive above the virtual ground. The level of support and compliance during swing phase can be programmed.
              All these demands lead to a universal haptic walking simulator with high


              Originally posted by Wise Young:

              Wernig in Bonn Germany reported nearly 10 years ago that intensive locomotor training on a treadmill (laufband) can restore independent locomotion in as many as 40% of patients who have never walked after injury and as long as 10 years after injury. This was greeted with skepticism by many rehabilitation doctors in the beginning but the data now being collected both in Europe and the U.S. in NIH-funded and other clinical trials suggest that such training can restore function. The rationale is that neuronal circuits turn off when they are not used for long periods of time. I don't think that it is necessarily "new" circuits as much as waking up dormant circuits. In the old days, when everybody was discouraged from trying to walk, even when they are "incomplete", learned non-use was probably much more frequent than it is today. In Europe, there are rehabilitations centers that are beginning the locomotor training within weeks after spinal cord injury, in an effort to prevent learned non-use. Several questions have yet to be answered. How much and what is the best form of exercise? If 4-6 hours per day necessary? Is it really only for people with "incomplete" injuries. Those studies are going on right now and I think that the answer will be that intensive exercising will be necessary, that supported ambulation is not the only way, and that people with "complete" spinal cord injury will also benefit from the exercise even if they do not regain independent locomotion. Finally, I don't think that this is snake oil and it does suggest a new approach towards restoration of the function to many people with chronic spinal cord injury.

              • Wernig A and Muller S (1992). Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries. Paraplegia. 30 (4): 229-38. Summary: After low transection of the spinal cord mammalian quadrupeds can be trained to walk on a driven surface indicating that coordinating neuronal circuits persist in the spinal cord segments caudal to the lesion. We trained 8 persons with incomplete spinal cord lesion on a Laufband (driven treadmill) for 1 1/2 to 7 months (5 days a week, 30-60 minutes daily) starting 5 to 20 months after injury and found significant improvement in the utilisation of the paralysed limbs during locomotion. Locomotion is described in one additional patient who had trained independently on parallel bars for several years. Five patients had complete functional paralysis in one lower limb when tested in a resting position. In EMG recordings voluntary activity (ie activity induced upon command) was absent or residual in the main flexor and extensor muscles of this limb. In contrast, during locomotion flexion and extension movements were performed and phasic EMG activity was present. In these 5 patients, and in all others reported here, skin sensibility and proprioception are preserved to different degrees in all limbs. In the course of locomotive training of 4 severely paralysed patients the initially habituating flexion reflexes could be entrained in the paralysed limbs as was the case for knee extension during stance. Subsequently, initial body weight support (BWS) of 40% could be reduced to 0%. The distance covered on the Laufband (0-104 m in the first week) increased significantly (200-410 m) in the last week of training as did speed (0-10 to 14-23 m/min). More importantly, this training subsequently allowed patients to walk on a static surface for 100 to 200 meters while voluntary activity remained absent in the paralysed limb when tested at rest. Similar progress was achieved in the 4 less severely paralysed patients. The one patient who had trained independently on parallel bars for several years is described walking on a static surface for 40 meters with the help of a walker, though he had one completely and one near completely paralysed lower limb. It appears that bipedal stepping with consequent knee extension and stabilisation can be taught after unilateral complete or near complete loss of voluntary activity, suggesting the manifestation of complex reflex motor patterns at the spinal level. Department of Physiology, University of Bonn, FRG.
              • Wernig A, Muller S, Nanassy A and Cagol E (1995). Laufband therapy based on 'rules of spinal locomotion' is effective in spinal cord injured persons. Eur J Neurosci. 7 (4): 823-9. Summary: 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). Department of Physiology, University of Bonn, Germany.
              • Wernig A, Nanassy A and Muller S (1998). Maintenance of locomotor abilities following Laufband (treadmill) therapy in para- and tetraplegic persons: follow-up studies. Spinal Cord. 36 (11): 744-9. Summary: Recent reports indicate that walking capabilities in spinal cord damaged persons significantly improve--as compared to conventional rehabilitation therapy--after intensive training of aided (Laufband) treadmill-stepping. In the present report, follow up investigations on two collectives of spinal cord injured (sci) persons are described who had undergone (Laufband) treadmill therapy either during a period of renewed rehabilitation months or years after spinal cord injury (35 chronic patients) or during their first postacute rehabilitation period (41 acute patients). Among the initially chronic patients, 20 from 25 still wheelchair-bound before the onset of (Laufband) treadmill therapy, ie not capable of raising from the wheelchair and walking without help by other persons, became independent walkers after therapy. Assessment of voluntary muscle activity in resting position before and after the period of therapy had shown only small increases in most patients, indicating the involvement of motor automatisms and better utilisation of remaining muscle function during walking. Follow-up assessments performed 6 months to 6 1/2 years after discharge from the hospital revealed that the walking capabilities achieved by (Laufband) treadmill therapy in the 35 initially chronic patients were maintained in 31 persons, in three they had further improved, in only one it was reduced. These results indicate that the improvements achieved under clinical conditions can be maintained in every day life under domestic surroundings. From 41 initially acute patients, 15 had further improved and none had reduced his walking capability 6 months to 6 years after discharge from the hospital. Department of Physiology, University of Bonn, Germany.
              • Wernig A, Nanassy A and Muller S (1999). Laufband (treadmill) therapy in incomplete paraplegia and tetraplegia. J Neurotrauma. 16 (8): 719-26. Summary: Recent reports indicate that intensive training of upright walking on a treadmill (German: Laufband, LB), significantly improves walking capability in spinal cord-damaged persons. The aids provided initially are body weight support by a harness and passive setting of one or both limbs by therapists. To facilitate stepping and evoke motor automatisms, "rules of spinal locomotion" need to be applied during training. The effects of this novel locomotion therapy on patients with chronic and acute incomplete paralysis are summarized and discussed here. Many patients with chronic paralysis, still wheelchair-bound and not capable of walking without help from others, became independent and learned to walk for some distance without help. Assessment of voluntary muscle activity in resting position before and after the period of therapy often showed only small increases, rendering the involvement of complex motor reflexes (motor programs) and better utilization of remaining muscle function during walking as main sources for the improvements in locomotion. This idea is supported by electromyographic recordings. Follow-up assessments performed 0.5 to 6.5 years after discharge from the hospital show that the significant improvements achieved by LB-therapy in patients with initially chronic paralysis can be maintained under domestic surrounding. Patients with initially acute paralysis improved their walking capabilities even further. It is suggested that LB therapy may be generally applied in the motor rehabilitation of persons with acute and chronic incomplete paraplegia and tetraplegia. Its use in other diseases is discussed. Department of Physiology, University of Bonn, Germany. wernig@physio.uni-bonn.de.
              • Wernig A, Nanassy A and Muller S (2000). Laufband (LB) therapy in spinal cord lesioned persons. Prog Brain Res. 128: 89-97. Summary: Department of Physiology, University of Bonn, Germany. wernig@physio.uni-bonn.de.

              Originally posted by Wise Young:


              Reference Type: Journal Article
              Record Number: 276
              Author: Wernig, A.; Muller, S.
              Year: 1992
              Title: Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries
              Journal: Paraplegia
              Volume: 30
              Issue: 4
              Pages: 229-38
              Date: Apr
              Accession Number: 1625890
              Keywords: Adult
              Body Weight
              Electromyography
              Human
              *Locomotion
              Middle Age
              Paraplegia/*therapy
              Spinal Cord Injuries/*therapy
              *Walking
              Abstract: After low transection of the spinal cord mammalian quadrupeds can be trained to walk on a driven surface indicating that coordinating neuronal circuits persist in the spinal cord segments caudal to the lesion. We trained 8 persons with incomplete spinal cord lesion on a Laufband (driven treadmill) for 1 1/2 to 7 months (5 days a week, 30-60 minutes daily) starting 5 to 20 months after injury and found significant improvement in the utilisation of the paralysed limbs during locomotion. Locomotion is described in one additional patient who had trained independently on parallel bars for several years. Five patients had complete functional paralysis in one lower limb when tested in a resting position. In EMG recordings voluntary activity (ie activity induced upon command) was absent or residual in the main flexor and extensor muscles of this limb. In contrast, during locomotion flexion and extension movements were performed and phasic EMG activity was present. In these 5 patients, and in all others reported here, skin sensibility and proprioception are preserved to different degrees in all limbs. In the course of locomotive training of 4 severely paralysed patients the initially habituating flexion reflexes could be entrained in the paralysed limbs as was the case for knee extension during stance. Subsequently, initial body weight support (BWS) of 40% could be reduced to 0%. The distance covered on the Laufband (0-104 m in the first week) increased significantly (200-410 m) in the last week of training as did speed (0-10 to 14-23 m/min). More importantly, this training subsequently allowed patients to walk on a static surface for 100 to 200 meters while voluntary activity remained absent in the paralysed limb when tested at rest. Similar progress was achieved in the 4 less severely paralysed patients. The one patient who had trained independently on parallel bars for several years is described walking on a static surface for 40 meters with the help of a walker, though he had one completely and one near completely paralysed lower limb. It appears that bipedal stepping with consequent knee extension and stabilisation can be taught after unilateral complete or near complete loss of voluntary activity, suggesting the manifestation of complex reflex motor patterns at the spinal level.
              Notes: 0031-1758
              Journal Article
              URL: http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=1625890
              Author Address: Department of Physiology, University of Bonn, FRG.
              Reference Type: Journal Article
              Record Number: 273
              Author: Wernig, A.; Muller, S.; Nanassy, A.; Cagol, E.
              Year: 1995
              Title: Laufband therapy based on 'rules of spinal locomotion' is effective in spinal cord injured persons
              Journal: Eur J Neurosci
              Volume: 7
              Issue: 4
              Pages: 823-9
              Date: Apr 1
              Accession Number: 7620630
              Keywords: Acute Disease
              Chronic Disease
              Comparative Study
              Electrophysiology
              Exercise
              Human
              Locomotion/*physiology
              Muscle, Skeletal/physiopathology
              Paralysis/rehabilitation
              Reflex, Stretch/physiology
              Spinal Cord/*physiology
              Spinal Cord Injuries/physiopathology/*rehabilitation
              Support, Non-U.S. Gov't
              Walking
              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)
              Notes: 0953-816x
              Clinical Trial
              Controlled Clinical Trial
              Journal Article
              URL: http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=7620630
              Author Address: Department of Physiology, University of Bonn, Germany.

              Comment


                #22
                Originally posted by Dogger:


                if you have reasonable upper body strength wouldn't a trainer that has levers [connected to feet pedals ] for arm/shoulder workout be better ? i mean one without a motor drive . you would be working out other parts of the body while providing the leg motion and if there is any functional leg return , this would be made to work as well .
                thank you ,
                dogger
                Yes Dogger,

                I agree with your comments. A patient with incomplete paralyses such as you seems to have different aspects than complete paralyses. Walking can be (re)learned by walking" and the "rules of spinal locomotion" facilitate stepping sometimes even with very little voluntary movement remaining. What does a "normal" gait pattern mean? A "normal" gait pattern includes arm/shoulder movements as you have previously commented above. We could also include the trunk and proper head position. Many patients may find proper arm swing impossible, either due to complete quadriplegia, knee or trunk instability or anxiety or many other reasons. You might want to also try some visual feedback such as a mirror.

                Does this make sense?

                Janet [img]/forum/images/smilies/smile.gif[/img]

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                  #23
                  Chris D, Piela, Dodger
                  Awesome discussion!!
                  Where else in the world could you find equipment options, methods for walking research, peronal experience.....which include short term and long goals for both para and quads. I am curious about the Elliptical brand you prefer.[img]/forum/images/smilies/smile.gif[/img] I am quite sure there isn't a professional in my area that could offer the insight you all provide. Thank you!

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                    #24
                    The Mom,

                    You're welcome, good luck.

                    Please let us know what you decide to do for your C6-7 patient.

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                      #25
                      We're looking for a harness type apparatus for Luke to use over his parallel bars. Anyone have any ideas. I like the meat hook image. I pictured the Rocky movie. Also, a way to put up a track so he can travel from one end to the other??
                      Thanks Luke's Mom

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                        #26
                        SCI MOM,

                        I've given quite a few of our members the following info. Others have also asked for this info. I need to warn all of you not to use the industrial harness from Maine Anti-Gravity. This harness has hurt my shoulder given it supports only under your arms. Instead go to www.e-zwalker.com and find a harness that looks like theirs.

                        Deb

                        Another Care/Cure member suggested I buy an Proform Ellipital trainer instead of a treadmill. This allows you to use your arms to move your legs. I bought the Proform 505S for $330. Website is www.buychoice.com/buychoice/statics/ellipitals. Obviously this will only work for quads that have arm strength and paras. For quads w/o arm strength use a treadmill.

                        Regarding the hoist, my fiance built one. Basically it is just a modified engine hoist. You hook the safety harness up to the hoist and raise up your body until you aren't supporting all your weight. Look at websites that show gait training and have someone modify the engine hoist to match the lift. I'll post a picture of the one Wayne built as soon as my new harness comes in.

                        Let me know if you need more info.


                        Debbie7
                        "Save the last dance for me!"

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                          #27
                          ...
                          [decided to post in new thread instead]
                          Last edited by dan_nc; 10 Feb 2006, 11:05 PM.
                          Daniel

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