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Thread: Lite Gait Training

  1. #1
    Senior Member teesieme's Avatar
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    Lite Gait Training

    Yes, my son has been finally accepted to begin a lite gait training program! And within a reasonable distance from our home too!
    So my question for you is: from your personal experiences of and/or professional opinions, what is most important overall with this type of training such as the testing beforehand, the harness fit, use of his leg braces to start with, etc...
    I have the basics covered I believe but would like some advice, reminders what to look for and personal experiences otherwise to calm some fears while being truly excited for my son to finally have this chance! WooHoo!

  2. #2
    Wow, Teesieme,
    That's great! And not too far from home!? Priceless!
    Dan could never qualify for lite gait training, So we rented one ourselves! Then my husb. Big Dan built one!
    B/c Dan doesn't have much trunk control, it was difficult, but that's where we saw his first reflex come back! The most difficult was getting the harness perfect.
    That is wonderful news, keep us posted!
    Cathy and Dan J

  3. #3
    teelieme, this is great news! I have some good experience with this so I will take a shot at your questions. I first trained in a Lite Gait a bit over two years ago at the U of Washington when I was starting to walk again. Right now, I am in a clinical trial at the U of Florida, using Robomedica equipment, where I have learned tons about all this .. and my walking is improving as well.

    First, he should not use braces! While suspended his legs need to be free so all his muscles and joints can move as they are supposed to. He will need a person on each leg to help lift it, move it forward, and ensure a good heel strike. The theory is that this retrains the neurons in the lower spinal cord, and you want to "program" it with the best possible information. They will start him out at slow speeds and higher body weight support. Over time they will probably be able to increase the speed, reduce the body weight support, and reduce the need for assistance.

    The harnesses I have been in have all been less than ideal. They will squeeze his torso like a corset, and they have straps that go between the legs .. uncomfortable but necessary to support his weight. They should take the time to make sure the harness fits properly, and if he gets up on the treadmill and something isn't right, they should stop and fix it. How is his sensation? If he is getting squeezed .. well you know where .. will he feel it?

    Regarding testing, it would be good to have a baseline of muscle strength. I'd suggest strength testing the major muscle groups in his trunk and legs: hip flexors, hip abductors and adductors, gluteus maximus, hamstrings, quadriceps, ankle dorsiflexors and plantarflexors (if you don't know what some of these are, please ask!). Perhaps the lower perispinals and abdominals as well, though they are harder to isolate. These are more muscles than used in the ASIA scoring, but he could show improvement in any of them so having the baseline is good. An ASIA sensation exam is less important, but could show sensation changes, if any.

    Now some questions for you: I can't recall your son's injury level, time since injury or ASIA letter grade. Can you tell me all that? How often will he train, and for how many total sessions? Is the equipment actually made by Lite Gait or another manufacturer? How much experience in body weight supported treadmill training does the therapist leading the training have? I seem to recall that your son can walk with a walker and braces. Is that correct? How far can he walk?

    There's more to tell you but this is enough for tonight.

    - Bruce

  4. #4
    Senior Member teesieme's Avatar
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    TY~ Cathy and Dan J. Yes, it has been almost two years of pursuing as such, being taken seriously about wanting of it and through someone who seems to have knowledge of and experience with it.
    I have such hope for my son with this, otherwise it will ready him for other decisions to be made down the road and then thereafter... I am happy for Dan that you and Big Dan were determined and able to get this figured out for him and the first reflex coming of it!!!

    Okay, Bruce. TY also for all the info. and questions for the sake of my son. Yes, I have heard the harness is the toughest as Cathy has said also. This happens to be one of my concerns. Yes, Harry has sensation enough to know if there is discomfort or squeezing, I believe. I wondered then, about purchasing something you all who have trained in, would agree upon as a good choice. This lite gait machine isn't a new model btw, thus my concern even more about the harness and not knowing it's brand name but it is a lite gait type. I can find out though before he begins.

    The lead therapist's experience, I actually did not check into, it came through his physicians recommendation once he tried the FES bike elsewhere and had results within five sessions of. I will ask a very trusted in-patient therapist there, his opinion and knowledge of her, this will calm that concern then without questioning her skills outright. I can say that this first evaluation left me with the impression that she was very thorough about things more so than I have seen in many examinations/evaluations otherwise. She did tell Harry that it would take two to three weeks to schedule two other persons to assist in this, that it would be a five day a week therapy session and they haven't had someone there yet with his injury level who gained movement from it but he might be the one to do so. From what the kid told me so far of their conversation, she is both very serious and knowledgeable and positive about this type of therapy/retraining.

    Harry is T5&6, a little over two years post. If I remember correctly his ASIA grade is B showing possibly more? Yes, my son is able to walk with leg braces and a walker, distance is limited within our small home or deck. But what he does is about 25 ft. I would say, then leans forward into his walker to stretch his feet some, and practices his balance without holding onto the walker for as long as he can, with his arms out, off to the side, then straight down and does what hip swinging he can manage holding onto the walker. Once he finishes that part of the session, he turns around and goes another 25 ft. I have noted his posture has improved over time now and his hip swing exercise seems to be better too...

    oh wow, getting a novel here...heh.

    As for a baseline of muscle strength, maybe this was what she was doing with the evaluation as I watched from a distance every so often without being the mother hen I can obviously be, having him lay on his stomach and lift his upper torso as high as he could, etc. He has been tested in different ways throughout this past year or so, in research through the Shriner's for muscle fatigue, through biofeedback last summer in which he gained control and probably with the FES bike currently I would assume.

    And yes, I wondered about using the leg braces at first or not? How about shoes with ankle support or something as such? Harry does not have any noted movement below his thighs and worries constantly about a slight curve that has come about within his left leg, which has been examined, w/ no statement of concern verbally each time asked about, except for something I just found while reading his through his medical transcripts of appts. stating to consider a bone scan to further evaluate possible sclerosis in the distal femur and proximal tibia??? A bone density test otherwise, ending up to be only of his hips, which read as a T score of 0, Z score unavailable and 1.035 under the BMD g/cm2? Impression: Normal bone mineral bone density of the hip.

    I am truly happy for you that your walking is improving with the Robomedica equipment, I had hoped Harry would be asked to and accepted last fall for something I believe is similar through the Miami Project but wasn't. I just see things happening even minimally with my son that I believe it may just trigger some sleepy action, we will see what comes of it! Just so he is healthy enough to do so and safe in his efforts.

    Thank you so much for caring and taking the time to go into such detail and sharing your experiences with me. I look forward to more! And now I think I should end my novel for the time being... Take care~ Teresa

  5. #5
    Teresa, here's my novel back to you

    First the harness .. I'd suggest not worrying about it, it's a fact of life for this therapy. I find it doesn't really bother me except when I take a rest, then I have them reduce the body weight support which reduces the discomfort.

    It sounds like your the therapist has experience with this and has worked with others with success. You mention she said that no one with his injury level has gained movement, but injury level has little to do with it unless the injury is around L1-L2, where the central pattern generator is supposed to reside. Having the other people to help is necessary.

    I'd guess that Harry is ASIA C as it seems he has movement below his neurological level .. it sounds like he can move his quadriceps but not below. ASIA B is sensation at S4/S5 (the sphincter) but no movement below the neurological level. Anyway, I get a picture of what he is capable of right now.

    Regarding braces, again he should not train with any bracing unless there is a compelling medical reason to do so. Any type of constraint that restricts muscle or joint activity will interfere with the training. What he is not capable of will be made up from the body weight support and the assistants manually helping his legs.

    I wouldn't worry about the slight curve, unless it causes pain while he trains. However I would check with the doctor who wrote about the sclerosis and find out exactly what he/she meant. This would be in the knee area, but I don't understand it. The bone scan he had sounds like a dexa scan, which is used to evaluate for osteoporosis. I had one done and they looked at my L4/L5 verterbrae and at my hip. It's good he has normal bone density. I have osteoporosis and take Fosamax for it. It's pretty common in the SCI population.

    If you haven't read it, Wise has written a paper with good info about this called The Effects of Intensive Training on Motor Recovery which Seneca also has put in a sticky thread in this forum.

    Well, that's all for now. I'm happy to share what I know. Of course there's still more but we'll get to it in time. Take care!

    - Bruce

  6. #6
    Senior Member teesieme's Avatar
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    Okay, I won't worry too much about the harness then, it will probably be mentioned about rub marks, etc. to him and adjustment advice is noted!
    As for the injury level/movement, I think times are finally catching up there and although this isn't something new they have used, from what I could gather if there was a slight movement it was used, otherwise it wasn't.
    Yes, I thought maybe Harry would be at an ASIA C now also.
    Before Harry was injured he had flat feet and knee issues from that, wearing a sole insert to help with the pain from his knee caps being pulled off to the side... he has since worn them but I did get some new (a temporary type) made to the specifications of the other and a type of tennis shoe that offers some ankle support he has been breaking in for awhile now.
    A dexa scan is what had been ordered for other evaluations, what happened in that appt. was the person working it didn't accomodate adjustments needed for his disability with the table, it is a long story but she should be in trouble by now (and is deserving for the sake of the person w/ c. p. before his appt. more so that she talked to us about after I had demanded to know why it was only his hips scanned when doctors orders had requested otherwise)... in the end it was only his hips scanned. As for the knee, he had problems with his left knee six months back, a pulled hamstring of sorts that we were able to heal through more intense and increased therapy at home. This is the leg that was X-rayed, he has been worried about it for quite some time, thinking he sees a curve to it, in truth, I do too. I will ask for further testing of this. If there is sclerosis, however slight, does that risk his being a candidate for the gait walking?
    Okay, now that I have some time, I am going to read Wise's article~ TY Projectorguy!

  7. #7
    Senior Member teesieme's Avatar
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    Hey Projectorguy, almost two months later, he is readying to try the lite gait training...
    Good thing with the wait is that the therapist I would've loved to have for Harry all along, (the one I trust so very much) is one who will be working with him! Happy, happy, happy~

    Okay, here is the thing though~ that getting "squeezed" part has brought about a delay as they try to figure a way to reduce that pressure and pull upward. The normal cup deal is not going to work. What else is there out there? TY again.

  8. #8
    Teresa, great news! Except for the harness issues I don't know quite what to say about that. I don't exactly remember how the lite gait harness is set up there in that area, and i don't recall what the "normal cup deal" is. Maybe the harness your using is different, though it's been a couple years since I used a lite gait. In Florida, on the harness I used, I made sure that each of the crotch straps was as far towards my thigh as it could be, and that there was enough slack in my pants so things weren't too uncomfortable. Unfortunately there isn't a way around having to have support there

    The hookup on the top of the harness uses, as I recall, connectors like a seat belt. If you used another harness those would have to be adapted .. possible but not easy.

    That's what I can think of right now. BTW, I'm flying to Minneapolis tomorrow .. it's where I grew up, and I was born in Duluth. Good luck!

    - Bruce

  9. #9
    Senior Member teesieme's Avatar
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    Really, you are in Mn. then? If you get this quick enough, are you going to be coming up the Duluth way then or have some free time and car to meet half way at Hinckley~ cause it would be cool to meet you!!!

    Yeah, going to have to do some searching for different harnesses most likely~ thinking some of that sheepskin padding around the straps would help some, possibly.

    The p.t. said they are getting a new lite gait machine soon also.

    Okay, gotta get going here, kid is in a mudbog race today. Woo hoo!!!

  10. #10
    Check your private topics re: MN.

    So it sounds like the harness just isn't going to work .. too bad you have to hassle about that

    A mudbog race? Not familiar with what that is but I can imagine a big pool of mud with some type of motor vehicles and a great big mess. Does your son do this? In a vehicle with hand controls or what?

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