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Thread: Questions on treadmill therapy for Dr. Young or others.

  1. #1
    Senior Member bill j.'s Avatar
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    Questions on treadmill therapy for Dr. Young or others.

    Dr, Young, there seems to be a lot of interest in what is being called laufband, treadmill, locamote, or constant use therapy. But I think most of us know very little about it.

    After two years of intense therapy and "hard work" with no improvement, I came to reject the idea that hard work itself would lead to improvement. Therefore, I believe there is more to treadmill therapy than hard work. For example, would I be correct in believing that it takes precise movements, repeated hundreds or perhaps thousands of times to reprogram the cord? Is there more to it than that? For example, I am t-12. I can flex my quad muscles somewhat and have been able to do that since I got home from the hospital. In a swimming pool, I can very crudely make my legs move in a motion that resembles peddling a bike but I cannot support an ounce of weight. There has been no noticeable improvement over 5 years in leg movements nor was there improvement when I was doing pool exercises (peddling) for an hour daily. Now I am wondering, based on results of treadmill therapy, if the only way improvement would come is by working (peddling) for six to eight hours daily.

    Furthermore, I have read about so-called "boot camps" for the sci that have been tried periodically where patients are worked very hard. But I know of no one that got improvement from them. In my opinion, "boot camps" are sort of a fad that comes and goes periodically. I suspect that if improvement is now coming from treadmill therapy, it is because of hard work combined with the right length of times and the right techniques. What I mean is, it is probably much more than just hard work alone; it is hard work combined with good science, something "boot camps" do not provide.

    Do you think it is possible, based on what is now known, that longer therapy sessions of repeated motion is likely to restore function in someone like me? For example, would peddling my legs for 8 hours daily in a swimming pool lead to improvement? Or would starting my own treadmill therapy and having someone move my legs for 6-8 hours daily lead to improvement or maybe even walking? Or is there more to it than that?

    More questions: does anyone really know what is happening with treadmill therapy? It seems to me it is sort of a "bottoms up" approach. Does repeatedly moving the legs, for example, stimulate growth of axons across the injury site and towards the brain? And if so, would these be sensory axons only? Or does repeated step-like motion just somehow only "reprogram" a section of the cord like the central pattern generator? If this is the case, then I suspect feeling cannot be regained. But if feeling cannotbe regained, what good is it all going to do? Does treadmill therapy also improve sensation? The only way for sensation to be regained is for axons to cross the injury site, right? Does treadmill therapy improve bowl and bladder control, or just walking?

    Isn't a ventilator sort of a form of treadmill therapy in that it produces a repeated movement for long periods of time? If so, why does not this alone not lead to people getting off the vent?

    Do you or anyone know of someone who is an expert in this field that would come here to discuss their findings?

    Bill

    [This message was edited by bill j. on Mar 29, 2002 at 12:16 PM.]

  2. #2
    Bill J,

    Reggie Edgarton is a good friend and he, in my opinion, is the best in the field. Maybe I can convince him to come on board to answer some questions. Several things are becoming apparent, at least to me in the past year, regarding the supported ambulation therapy.

    1. Cervical spinal cord injury patients may respond better to such training because their neuronal circuits in the lumbar region have not been damaged. In your case, a T12 vertebral level may have damaged some of the lumbar spinal cord that is present in the T12 level.

    2. The treadmill training is different from pedalling. It is true walking with both motor and sensory patterning that walking provides. It is also very slow, particularly for people with "complete" spinal cord injuries.

    3. L2 stimulation of the lumbar locomotor center (that is now the preferred term over the more frequently used "central pattern generator) may markedly accelerate training of the lumbar cord to respond appropriately to incoming signals.

    4. Some investigators (including Volker Dietz, and others) believe that involving arm movements in the exercise program is very important. As you know, the arms have neural connections to the legs (our ancestor species were quadripeds). There are attempts now to develop machines that use the arm movements to facilitate the locomotor training. Dr. Giselher Schalow in Nottwill, Switzerland has this machine that is intriguing. It is very simple, consisting of a bilateral arm crank that is connected by chain to a bilateral leg crank. People who are hemiplegic can use one side to provide motivating movement for the paralyzed side. People who are paraplegic can use their arms to propel their lower limbs. This can be combined with FES as well.

    Finally, it is really important to point out that these types of training, while very important for restoring function, by themselves may not restore that much function. I am very concerned that regeneration alone will not do it and that we must implement rigorous and systematic training to teach the spinal cord to respond to descending signals as a network.

    Wise.

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