Body Weight Support Locomotion Training in Spinal Cord Injured Patients

Česká verzia

Authors: J. Kříž; P. Káfuňková; B. Schreier; P. Kolář
Authors place of work: Spinální jednotka, Klinika rehabilitace a tělovýchovného lékařství UK 2. LF a FN v Motole, Praha
Published in the journal: Cesk Slov Neurol N 2010; 73/106(2): 124-130
Category: Review Article

Summary

Body weight support locomotion training is a classical rehabilitation method in patients who have suffered injury to the spinal cord. It is based on the discovery that repetitive cyclic passive movements can stimulate locomotor centres in the spinal cord. Numerous studies have documented motor recovery in vertebrate animals and in incomplete spinal‑ cord‑ injured humans. Manual‑ assisted, body‑ weight support treadmill training requires a large number of physiotherapists working in an ergonomically inconvenient position. New approaches to robotic locomotion training are therefore being developed. The aim is to design a device that provides minimal necessary locomotion assistance depending on the severity of the motor impairment.

Key words:
spinal cord injury – plasticity – locomotion – rehabilitation – robotic device – treadmill

Zdroje

1. Raineteau O, Schwab ME. Plasticity of motor system after incomplete spinal cord injury. Nat Rev Neurosci 2001; 2(4): 263–273.

2. Curt A, Van Hedel HJ, Klaus D, Dietz V, EM‑SCI Study Group. Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma 2008; 25(6): 677–685.

3. Duysens J, Van de Crommert HW. Neural control of locomotion; The central pattern generator from cats to humans. Gait Posture 1998; 7(3): 131–141.

4. Dietz V, Harkema SJ. Locomotor activity in spinal cord‑injured persons. J Appl Physiol 2004; 96(5): 1954–1960.

5. Dietz V. Body weight supported gait training: from laboratory to clinical setting. Brain Res Bull 2009; 78(1): I–VI.

6. Wilson P, Kitchener PD. Plasticity of cutaneous primary afferent projections to the spinal dorsal horn. Prog Neurobiol 1996; 48(2): 105–129.

7. Thomas SL, Gorassini MA. Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury. J Neurophysiol 2005; 94(4): 2844–2855.

8. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000; 288(5472): 1765–1769.

9. Lam T, Wirz M, Lünenburger L, Dietz V. Swing phase resistance enhances flexor muscle activity during treadmill locomotion in incomplete spinal cord injury. Neurorehabil Neural Repair 2008; 22(5): 438–446.

10. Behrman AL, Harkema SJ. Locomotor training after human spinal cord injury: a series of case studies. Phys Ther 2000; 80(7): 688–700.

11. Crone C, Nielsen J, Petersen N, Ballegaard M, Hultborn H. Disynaptic reciprocal inhibition of ankle extensors in spastic patients. Brain 1994; 117(5): 1161–1168.

12. Field‑Fote EC, Lindley SD, Sherman AL. Locomotor training approaches for individuals with spinal cord injury: a preliminary report of walking-related outcomes. J Neurol Phys Ther 2005; 29(3): 127–137.

13. Mehrholz J, Kugler J, Pohl M. Locomotor training for walking after spinal cord injury. Spine 2008; 33(21): E768–E777.

14. Hicks AL, Ginis KA. Treadmill training after spinal cord Injury: it’s not just about walking. J Rehab Res Dev 2008; 45(8): 241–248.

15. Morrison SA, Backus D. Locomotor training: is translating evidence into practice financially feasible? J Neurol Phys Ther 2007; 31(2): 50–54.

16. Behrman AL, Lawless‑Dixon AR, Davis SB, Bowden MG, Nair P, Phadke C et al. Locomotor traning progression and outcomes after incoplete spinal cord injury. Phys Ther 2005; 85(12): 1356–1371.

17. Hornby TG, Zemon DH, Campbell D: Robotic‑assisted, body‑weight‑supported treadmill training in individuals following motor incomplete spinal cord injury. Phys Ther 2005; 85(1): 52–66.

18. Visintin M, Barbeau H. The effects of body weight support on the locomotor pattern of spastic paretic patients. Can J Neurol Sci 1989; 16(3): 315–325.

19. Wirz M, Colombo G, Dietz V. Long term effects of locomotor training in spinal humans. J Neurol Neurosurg Psychiatry 2001; 71(1): 93–96.

20. Harkema SJ, Hurlley SL, Patel UK, Requejo PS, Dobkin BH, Edgerton VR. Human lumbosacral spinal cord interprets loading during stepping. J Neurolophysiol 1997; 77(2): 797–811.

21. Dietz V, Colombo G, Jensen L, Baumgartner L. Locomotor capacity of spinal cord in paraplegic patients. Ann Neurol 1995; 37(5): 574–582.

22. Bauman WA, Kahn NN, Grimm DR, Spungen AM. Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury. Spinal Cord 1999; 37(9): 601–616.

23. Phillips SM, Stewart BG, Mahoney DJ, Hicks AL, McCartney N, Tang JE et al. Body‑weight‑support treadmill training improves blood glucose regulation in persons with incomplete spinal cord injury. J Appl Physiol 2004; 97(2): 716–724.

24. Adams MM, Ditor DS, Tarnopolsky MA, Phillips SM, McCartney N, Hicks AL. The effect of body weight‑supported treadmill training on muscle morphology in an individual with chronic, motor‑complete spinal cord injury: A case study. J Spinal Cord Med 2006; 29(2): 167–171.

25. Giangregorio LM, Webber CE, Phillips SM, Hicks AL, Craven BC, Bugaresti JM, McCartney N. Can body weight supported treadmill training increase bone mass and reverse muscle atrophy in individuals with chronic incomplete spinal cord injury? Appl Physiol Nutr Metab 2006; 31(3): 283–291.

26. Hicks AL, Adams MM, Ginis KA, Giangregorio LM, Latimer A, Phillips SM et al. 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. Spinal Cord 2005; 43(5): 291–298.

27. Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 2000; 37(6): 693–700.

28. Schmidt H, Werner C, Bernhardt R, Hesse S, Krüger J. Gait rehabilitation machines based on programmable footplates. J Neuroeng Rehabil 2007; 4: 2.

29. Riener R, Lünenburger L, Colombo G. Human‑centered robotics applied to gait training and assessment. J Rehabil Res Dev 2006; 43(5): 679–694.

30. Lünenburger L, Colombo G, Riener R. Biofeedback for robotic gait rehabilitation. J Neuroeng Rehabil 2007; 4: 1.

31. Hidler JM, Wall AE. Alterations in muscle activation patterns during robotic‑assisted walking. Clin Biomech 2005; 20(2): 184–193.

32. Mantone J. Getting a leg up? Rehab patients get an assist from devices such as HealthSouth’s AutoAmbulator, but the robots‘ clinical benefits are still in doubt. Mod Healthc 2006; 36(7): 58–60.

33. Aoyagi D, Ichinose WE, Harkema SJ, Reinkensmeyer DJ, Bobrow JE. A robot and control algorithm that can synchronously assist in naturalistic motion during body‑weight‑supported gait training following neurologic injury. IEEE Trans Neural Syst Rehabil Eng 2007; 15(3): 387–400.

34. Emken JL, Harkema SJ, Beres‑Jones JA, Ferreira CKand Reinkensmeyer DJ. Feasibility of Manual Teach‑-and‑Replay and Continuous Impedance Shaping for Robotic Lokomotor Training Following Spinal cord Injury. IEEE Trans Biomed Eng 2008; 55(1): 322–334.

35. Freivogel S, Mehrholz J, Husak‑Sotomayor T, Schmalohr D. Gait training with the newly developed ‚LokoHelp‘‑system is feasible for non‑ambulatory patients after stroke, spinal cord and brain injury. A feasibility study. Brain Inj 2008; 22(7–8): 625–632.

36. Hesse S, Uhlenbrock D. A mechanized gait trainer for restoration of gait. J Rehabil Res Dev 2000; 37(6): 701–708.

37. Hesse S, Werner C, Bardeleben A. Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury. Spinal Cord 2004; 42(6): 346–352.