Study of the effects of long-term weight-supported treadmill training

Wise Young · 02-08-2005, 06:29 AM

This study from McMaster University in Hamilton, Canda reports the effects of 12-month thrice weekly weight-supported treadmill training in 14 patients with incomplete (ASIA B & C) injuries. All the subject showed improved walking with significant reduction in body weight support required, 180% increase in treadmill walking speed, and 335% increase in distance walked per session. These improvements were sustained for up to 8 months after injury.

The results of this trial is consistent with many reports now that people with "incomplete" spinal cord injury do indeed benefit from weight-supported treadmill training. However, a multicenter American study that will be published soon showed that treadmill training is not essential for such recovery. The American study randomized patients during the first year after injury to standard rehabilitation or weight-supported treadmill training and 80% of both groups recovered walking.

What is different about this study is that all 14 of the patients are "chronic" (mean 7.4 years after injury). Thus, treadmill training improves locomotor recovery in people that are many years after injury.

1. Hicks, AL, Adams, MM, Martin Ginis, K, Giangregorio, L, Latimer, A, Phillips, SM and McCartney, N (2005). 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. 1Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. STUDY DESIGN:: Longitudinal, prospective within-subject design. OBJECTIVES:: (1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme. SETTING:: Hamilton, Ontario, Canada. METHODS:: A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up. RESULTS:: In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external body-weight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function. CONCLUSION:: Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.Spinal Cord advance online publication, 1 February 2005; doi:10.1038/sj.sc.3101710.

jb · 02-09-2005, 02:20 AM

i'm 3 1/2 yrs post injury asia a and i was told that treadmill training wouldn't do anything for me. i've tried it and the therapists were looking for something in the knee area that would tell them if i would benefit and they couldn't find what they were looking for. did anyone w/asia a try this and if so benefit?

fuentejps · 02-09-2005, 05:27 AM

most therapists dont know shit. if you want it demand it. i kow your still fairly new to sci, but you will learn to tell ppl (sci "SPECIALISTS") what you want, not what they think is best for you. Take control

Wise Young · 02-09-2005, 07:54 PM

jb, the conventional wisdom is that people with ASIA A neurological status will not regain independent walking with treadmill training. However, I know of at least one study from Switzerland that shows that people with ASIA A spinal cord injuries do get better locomotor reflexes and improve their treadmill walking.

One of the goals of regenerative therapies is to make people more incomplete so that such training will help them recover more.

Wise.

Corinne Jeanmaire · 01-10-2006, 02:52 PM

Quote:

Originally Posted by Wise Young

jb, the conventional wisdom is that people with ASIA A neurological status will not regain independent walking with treadmill training. However, I know of at least one study from Switzerland that shows that people with ASIA A spinal cord injuries do get better locomotor reflexes and improve their treadmill walking.

One of the goals of regenerative therapies is to make people more incomplete so that such training will help them recover more.

Wise.

Dr Young,
1. Positive effects of locomotor training for Asia A patients : Very interesting. Thanks a lot for this input !

2. I have recently developed the ability to bike on a motormed with my own strength. [>4 years post injury]. After spending hours litteraly 'fighting' with the motormed to add some power on top of the motor, I suddenly got spasms [which rarely happens to me]. They were first uncontrolled but enabled me to increase the bike speed. I am now able to control those spasms and to bike with some resistance without the motor. I still need the motor to be on at the very beginning, to start the movement, but I am able to increase/decrease the speed or stop when I want. I also need to keep a specific position to trigger and maintain the spasms/reflex movements [apparently as a counter reaction to streching some other muscles around the hip area as I lean forward].
I was wondering if this mechanism might also be repeated for a walking movement and whether it could be trained through a locomotor training ? Would it be a valid argument to start a serious and long term locomotor training in spite of having an álmost complete injury [T12 fracture. sensory : Asia A. Motor : Asia B not functional, ie a few muscles at level 1 only. A few new muscles recently appeared, after >4 years, further to more intensive therapy in the last 2 months !]

Thanks in advance !
kind regards. Corinne

carbar · 01-10-2006, 02:59 PM

That is very interesting reading Corinne - congratulations on these great results from your recent intensive therapy.
Can you tell me how you initiate the spasms that pedal the motomed? I mean, can you trigger them in the legs themselves or does the spasm come from movement of the body? I am in no way in the same position as you (T4 Asia A) but I do have a motomed and I have a lot of spasm that interferes with pedalling, but who knows maybe in time and with a lot of practice I might be able to generate a positive result like you!

jb · 01-13-2006, 02:38 PM

i've successfully convinced my pt to use me on the litegait. i've been using for 1hr/2x/wk. my speed has increased as well as endurance. i'm an asia a 4.5yrs post injury

Corinne Jeanmaire · 01-13-2006, 03:22 PM

Quote:

Originally Posted by jb

i've successfully convinced my pt to use me on the litegait. i've been using for 1hr/2x/wk. my speed has increased as well as endurance. i'm an asia a 4.5yrs post injury

jb,
how do you move your legs, with physiotherapist or with the lokomat or something like that ? You mention 1 hour twice a week. How long do you actually walk during this 1 hour ? how many % of you bodyweight is supported ? thanks for the info. Corinne

Corinne Jeanmaire · 01-13-2006, 03:19 PM

Quote:

Originally Posted by carbar

That is very interesting reading Corinne - congratulations on these great results from your recent intensive therapy.
Can you tell me how you initiate the spasms that pedal the motomed? I mean, can you trigger them in the legs themselves or does the spasm come from movement of the body? I am in no way in the same position as you (T4 Asia A) but I do have a motomed and I have a lot of spasm that interferes with pedalling, but who knows maybe in time and with a lot of practice I might be able to generate a positive result like you!

dear Carbar,
To initiate the spasm, I just have to lean forward in my chair, towards the motomed, while the motor is on. What it does is it's streching the hamstring muscle which then triggers some kind of reflex spasms in the legs and or in the buttocks. At this point I do not know which muscles are contracted.
It does not seem to be an extraordinary thing. I was with a c4 patient yesterday for which the same happened. But what is nice is that I manage to control that phenomenon and to use it . That was a real surprise to my physiotherapist who had to check about 3 times if I was really pedalling without the motor !!
take care. Corinne

sanadams · 02-09-2005, 08:26 PM

Dr YOung,
My son can tolerate standing for an hour (or longer if he was left there) in the suspended harness for the treadmill, taking almost full body weight. However, he starts to pass out in the standing frame and so has to come down to sitting. His therapists cannot figure it out. Do you have any idea why he would have a blood pressure drop in the standing frame but not when suspended on the treadmill?

02-08-2005, 06:29 AM	#1
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Study of the effects of long-term weight-supported treadmill training This study from McMaster University in Hamilton, Canda reports the effects of 12-month thrice weekly weight-supported treadmill training in 14 patients with incomplete (ASIA B & C) injuries. All the subject showed improved walking with significant reduction in body weight support required, 180% increase in treadmill walking speed, and 335% increase in distance walked per session. These improvements were sustained for up to 8 months after injury. The results of this trial is consistent with many reports now that people with "incomplete" spinal cord injury do indeed benefit from weight-supported treadmill training. However, a multicenter American study that will be published soon showed that treadmill training is not essential for such recovery. The American study randomized patients during the first year after injury to standard rehabilitation or weight-supported treadmill training and 80% of both groups recovered walking. What is different about this study is that all 14 of the patients are "chronic" (mean 7.4 years after injury). Thus, treadmill training improves locomotor recovery in people that are many years after injury. 1. Hicks, AL, Adams, MM, Martin Ginis, K, Giangregorio, L, Latimer, A, Phillips, SM and McCartney, N (2005). 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. 1Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. STUDY DESIGN:: Longitudinal, prospective within-subject design. OBJECTIVES:: (1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme. SETTING:: Hamilton, Ontario, Canada. METHODS:: A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up. RESULTS:: In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external body-weight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function. CONCLUSION:: Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.Spinal Cord advance online publication, 1 February 2005; doi:10.1038/sj.sc.3101710.

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02-09-2005, 02:20 AM	#2
jb Senior Member Join Date: Jan 2002 Location: USA Posts: 315	i'm 3 1/2 yrs post injury asia a and i was told that treadmill training wouldn't do anything for me. i've tried it and the therapists were looking for something in the knee area that would tell them if i would benefit and they couldn't find what they were looking for. did anyone w/asia a try this and if so benefit?

02-09-2005, 05:27 AM	#3
fuentejps Senior Member Join Date: Apr 2003 Location: OHIO Posts: 9,003	most therapists dont know shit. if you want it demand it. i kow your still fairly new to sci, but you will learn to tell ppl (sci "SPECIALISTS") what you want, not what they think is best for you. Take control

02-09-2005, 07:54 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	jb, the conventional wisdom is that people with ASIA A neurological status will not regain independent walking with treadmill training. However, I know of at least one study from Switzerland that shows that people with ASIA A spinal cord injuries do get better locomotor reflexes and improve their treadmill walking. One of the goals of regenerative therapies is to make people more incomplete so that such training will help them recover more. Wise.

01-10-2006, 02:59 PM	#6
carbar Senior Member Join Date: Dec 2004 Location: France Posts: 2,438	That is very interesting reading Corinne - congratulations on these great results from your recent intensive therapy. Can you tell me how you initiate the spasms that pedal the motomed? I mean, can you trigger them in the legs themselves or does the spasm come from movement of the body? I am in no way in the same position as you (T4 Asia A) but I do have a motomed and I have a lot of spasm that interferes with pedalling, but who knows maybe in time and with a lot of practice I might be able to generate a positive result like you!

01-13-2006, 02:38 PM	#7
jb Senior Member Join Date: Jan 2002 Location: USA Posts: 315	i've successfully convinced my pt to use me on the litegait. i've been using for 1hr/2x/wk. my speed has increased as well as endurance. i'm an asia a 4.5yrs post injury

02-09-2005, 08:26 PM	#10
sanadams Member Join Date: Aug 2004 Location: tampa FL Posts: 43	Dr YOung, My son can tolerate standing for an hour (or longer if he was left there) in the suspended harness for the treadmill, taking almost full body weight. However, he starts to pass out in the standing frame and so has to come down to sitting. His therapists cannot figure it out. Do you have any idea why he would have a blood pressure drop in the standing frame but not when suspended on the treadmill?