Supported ambulation treadmill (laufband) training in Bonn, Germany

Wise Young · 08-18-2001, 07:21 AM

• 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. <http://www.ncbi.nlm.nih.gov/htbin-po...id=0009848480> Department of Physiology, University of Bonn, Germany.

Wise Young · 01-07-2002, 05:42 AM

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.

Wise Young · 01-07-2002, 05:44 AM

Several U.S. studies have confirmed the above studies:

Reference Type: Journal Article
Record Number: 255
Author: Field-Fote, E. C.
Year: 2001
Title: Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury
Journal: Arch Phys Med Rehabil
Volume: 82
Issue: 6
Pages: 818-24
Date: Jun
Accession Number: 11387589
Keywords: Adult
*Electric Stimulation Therapy
Exercise Therapy/*methods
Female
Gait
Human
Male
Paralysis/*rehabilitation
Spinal Cord Injuries/*rehabilitation
Statistics, Nonparametric
Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S.
*Walking
Abstract: OBJECTIVE: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). DESIGN: Before and after comparison. SETTING: Miami Project to Cure Paralysis. PARTICIPANTS: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. INTERVENTION: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight-supported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. MAIN OUTCOME MEASURES: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. RESULTS: Over the course of training, there was a significant increase in OGWS (from.12 +/- 0.8m/s to .21 +/- .15m/s, p = .0008), treadmill walking speed (from .23 +/- .12m/s to.49 +/- .20m/s, p = .00003), and treadmill walking distance (from 93 +/- 84m to 243 +/- 139m, p = .000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p < .005 for each). CONCLUSIONS: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies.
Notes: 0003-9993
Clinical Trial
Journal Article
URL: http://www.mosby.com/scripts/om.dll/...820818&target=
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11387589
Author Address: Division of Physical Therapy and the Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, FL, USA. edee@miami.edu

Reference Type: Journal Article
Record Number: 254
Author: Protas, E. J.; Holmes, S. A.; Qureshy, H.; Johnson, A.; Lee, D.; Sherwood, A. M.
Year: 2001
Title: Supported treadmill ambulation training after spinal cord injury: a pilot study
Journal: Arch Phys Med Rehabil
Volume: 82
Issue: 6
Pages: 825-31
Date: Jun
Accession Number: 11387590
Keywords: Activities of Daily Living
Adult
Electromyography
Energy Metabolism
Exercise Therapy/*methods
Gait
Human
Male
Middle Age
Pilot Projects
Psychomotor Performance
Spinal Cord Injuries/*rehabilitation
Statistics, Nonparametric
Support, Non-U.S. Gov't
Support, U.S. Gov't, Non-P.H.S.
*Walking
Abstract: OBJECTIVES: To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. DESIGN: Quasiexperimental, repeated measures, single group. SETTING: Veterans Affairs medical center. PATIENTS: Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. INTERVENTION: Subjects participated in 12 weeks of training assisted by 2 physical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started at 40% of body weight and a treadmill speed of.16kmph, and progressed by reducing support and increasing treadmill speed and continuous treadmill walking time up to 20 minutes. Training was conducted for 1 hour per day, 5 days per week for 3 months. Treadmill walking occurred for 20 minutes during the sessions. MAIN OUTCOME MEASURES: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor control assessment; self-report indices; ASIA classification; muscle function test; and safety. RESULTS: All 3 subjects increased gait speed (.118m/s initially to.318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5min). The oxygen costs decreased from 1.96 to 1.33mL x kg(-1) x m(-1) after 12 weeks of training. CONCLUSIONS: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using objective gait measures. The self-report indices used have promise as patient-centered outcome measures of this new form of gait training. A larger, controlled study of this technique is warranted.
Notes: 0003-9993
Clinical Trial
Journal Article
URL: http://www.mosby.com/scripts/om.dll/...820825&target=
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11387590
Author Address: School of Physical Therapy, Texas Woman's University, Houston 77030-2897, USA. hf_protas@twu.edu

Reference Type: Journal Article
Record Number: 252
Author: Trimble, M. H.; Behrman, A. L.; Flynn, S. M.; Thigpen, M. T.; Thompson, F. J.
Year: 2001
Title: Acute effects of locomotor training on overground walking speed and H-reflex modulation in individuals with incomplete spinal cord injury
Journal: J Spinal Cord Med
Volume: 24
Issue: 2
Pages: 74-80
Date: Summer
Accession Number: 11587422
Abstract: OBJECTIVE: The purpose of this study was to assess the effect of a single bout of a locomotor-training paradigm on overground walking speed and H-reflex modulation of individuals with incomplete spinal cord injury (SCI). METHODS: Self-selected and maximum walking speeds and soleus H-reflexes (H/M ratios) during standing and stance and swing phases of walking (self-selected velocity) were obtained from 4 individuals with American Spinal Injury Association impairment classification D. Data were collected immediately before and after a single bout of locomotor training with body weight support on a treadmill. The pretraining H/M ratios of the SCI subjects were also compared with values from 4 able-bodied subjects who did not receive the intervention. Maximum H/M ratios while standing and during midstance and midswing phases of overground walking were considerably greater in the SCI subjects than in the control subjects. RESULTS: After the single bout of training, self-selected and maximum overground walking speeds of the subjects with SCI increased by 26% and 25%, respectively. Furthermore, H-reflexes were significantly more depressed in the SCI subjects during overground walking (28% less during stance, 34% less during swing). CONCLUSIONS: Although preliminary, these findings indicate that a single bout of locomotor training produced immediate increases in walking velocity and acute neurophysiologic changes in individuals with incomplete SCI.
Notes: 1079-0268
Journal Article
URL: http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11587422
Author Address: Department of Physical Therapy, University of Florida, Gainesville, USA.

Sue Pendleton · 01-10-2002, 10:12 PM

I have the full article from the 1995 journal and it has a mistake in the numbers of people who can walk up stairs independently after the triasl was over.

I am curious as to why when this kind of training proved remarkable improvement in both groups of chronics in Bonn and in another group in Zurich that here in the States we only use those acutely injured? Seems that "gold standard" would dictate using chronics in such cases where double blinds are not possible due to the therapy involved.

08-18-2001, 07:21 AM	#1
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Supported ambulation treadmill (laufband) training in 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. <http://www.ncbi.nlm.nih.gov/htbin-po...id=0009848480> Department of Physiology, University of Bonn, Germany.

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01-07-2002, 05:42 AM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	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.

01-07-2002, 05:44 AM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Several U.S. studies have confirmed the above studies: Reference Type: Journal Article Record Number: 255 Author: Field-Fote, E. C. Year: 2001 Title: Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury Journal: Arch Phys Med Rehabil Volume: 82 Issue: 6 Pages: 818-24 Date: Jun Accession Number: 11387589 Keywords: Adult Electric Stimulation Therapy Exercise Therapy/methods Female Gait Human Male Paralysis/rehabilitation Spinal Cord Injuries/rehabilitation Statistics, Nonparametric Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Walking Abstract: OBJECTIVE: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). DESIGN: Before and after comparison. SETTING: Miami Project to Cure Paralysis. PARTICIPANTS: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. INTERVENTION: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight-supported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. MAIN OUTCOME MEASURES: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. RESULTS: Over the course of training, there was a significant increase in OGWS (from.12 +/- 0.8m/s to .21 +/- .15m/s, p = .0008), treadmill walking speed (from .23 +/- .12m/s to.49 +/- .20m/s, p = .00003), and treadmill walking distance (from 93 +/- 84m to 243 +/- 139m, p = .000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p < .005 for each). CONCLUSIONS: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies. Notes: 0003-9993 Clinical Trial Journal Article URL: http://www.mosby.com/scripts/om.dll/...820818&target= http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11387589 Author Address: Division of Physical Therapy and the Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, FL, USA. edee@miami.edu Reference Type: Journal Article Record Number: 254 Author: Protas, E. J.; Holmes, S. A.; Qureshy, H.; Johnson, A.; Lee, D.; Sherwood, A. M. Year: 2001 Title: Supported treadmill ambulation training after spinal cord injury: a pilot study Journal: Arch Phys Med Rehabil Volume: 82 Issue: 6 Pages: 825-31 Date: Jun Accession Number: 11387590 Keywords: Activities of Daily Living Adult Electromyography Energy Metabolism Exercise Therapy/methods Gait Human Male Middle Age Pilot Projects Psychomotor Performance Spinal Cord Injuries/rehabilitation Statistics, Nonparametric Support, Non-U.S. Gov't Support, U.S. Gov't, Non-P.H.S. Walking Abstract: OBJECTIVES: To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. DESIGN: Quasiexperimental, repeated measures, single group. SETTING: Veterans Affairs medical center. PATIENTS: Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. INTERVENTION: Subjects participated in 12 weeks of training assisted by 2 physical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started at 40% of body weight and a treadmill speed of.16kmph, and progressed by reducing support and increasing treadmill speed and continuous treadmill walking time up to 20 minutes. Training was conducted for 1 hour per day, 5 days per week for 3 months. Treadmill walking occurred for 20 minutes during the sessions. MAIN OUTCOME MEASURES: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor control assessment; self-report indices; ASIA classification; muscle function test; and safety. RESULTS: All 3 subjects increased gait speed (.118m/s initially to.318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5min). The oxygen costs decreased from 1.96 to 1.33mL x kg(-1) x m(-1) after 12 weeks of training. CONCLUSIONS: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using objective gait measures. The self-report indices used have promise as patient-centered outcome measures of this new form of gait training. A larger, controlled study of this technique is warranted. Notes: 0003-9993 Clinical Trial Journal Article URL: http://www.mosby.com/scripts/om.dll/...820825&target= http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11387590 Author Address: School of Physical Therapy, Texas Woman's University, Houston 77030-2897, USA. hf_protas@twu.edu Reference Type: Journal Article Record Number: 252 Author: Trimble, M. H.; Behrman, A. L.; Flynn, S. M.; Thigpen, M. T.; Thompson, F. J. Year: 2001 Title: Acute effects of locomotor training on overground walking speed and H-reflex modulation in individuals with incomplete spinal cord injury Journal: J Spinal Cord Med Volume: 24 Issue: 2 Pages: 74-80 Date: Summer Accession Number: 11587422 Abstract: OBJECTIVE: The purpose of this study was to assess the effect of a single bout of a locomotor-training paradigm on overground walking speed and H-reflex modulation of individuals with incomplete spinal cord injury (SCI). METHODS: Self-selected and maximum walking speeds and soleus H-reflexes (H/M ratios) during standing and stance and swing phases of walking (self-selected velocity) were obtained from 4 individuals with American Spinal Injury Association impairment classification D. Data were collected immediately before and after a single bout of locomotor training with body weight support on a treadmill. The pretraining H/M ratios of the SCI subjects were also compared with values from 4 able-bodied subjects who did not receive the intervention. Maximum H/M ratios while standing and during midstance and midswing phases of overground walking were considerably greater in the SCI subjects than in the control subjects. RESULTS: After the single bout of training, self-selected and maximum overground walking speeds of the subjects with SCI increased by 26% and 25%, respectively. Furthermore, H-reflexes were significantly more depressed in the SCI subjects during overground walking (28% less during stance, 34% less during swing). CONCLUSIONS: Although preliminary, these findings indicate that a single bout of locomotor training produced immediate increases in walking velocity and acute neurophysiologic changes in individuals with incomplete SCI. Notes: 1079-0268 Journal Article URL: http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11587422 Author Address: Department of Physical Therapy, University of Florida, Gainesville, USA.

01-10-2002, 10:12 PM	#4
Sue Pendleton Moderator Join Date: Jul 2001 Location: Wisconsin USA Posts: 9,112	I have the full article from the 1995 journal and it has a mistake in the numbers of people who can walk up stairs independently after the triasl was over. I am curious as to why when this kind of training proved remarkable improvement in both groups of chronics in Bonn and in another group in Zurich that here in the States we only use those acutely injured? Seems that "gold standard" would dictate using chronics in such cases where double blinds are not possible due to the therapy involved.