Technological advances afford individuals with spinal cord injury (SCI) the ability to improve locomotor function through the use of body weight—supported (BWS) treadmill training. Rehabilitation providers now have the choice of BWS manual and robotic (i.e., Lokomat/Autoambulator) locomotor training (LT) systems to provide training in a safe treadmill environment. Several lines of evidence suggest that individuals with motor incomplete SCI who participate in intense LT can improve walking abilities and that these changes can be maintained for several months to years post LT. Health-related benefits of LT include increases in cross-sectional area of muscle, improved perception of health and physical capacity, and ultimately improved quality of life. Clinicians are challenged in making sound clinical decisions about which device to use, or in which order if both are available, due to the paucity of research comparing the manual and robotic systems for neural, functional, or health-related benefits after SCI. This article discusses evidence related to the manual and robotic systems for LT and describes the application of this evidence in developing a clinical decision-making algorithm for the use of manual and robotic LT in a postacute rehabilitation program for individuals with incomplete SCI.
Barbeau H, Norman K, Fung J, Visintin M, Ladouceur M. Does neurorehabilitation play a role in the recovery of walking in neurological populations? Ann N Y Acad Sci. 1998;860:377–392.
,
Does neurorehabilitation play a role in the recovery of walking in neurological populations?
, Ann N Y Acad Sci.
, vol. 860
(pg. 377
-392
) Morrison SA, Backus D. Locomotor training: is translating evidence into practice financially feasible? J Neurol Phys Ther. 2007;31(2):50–54.
,
Locomotor training: is translating evidence into practice financially feasible?
, J Neurol Phys Ther.
, vol. 31
(pg. 50
-54
) De Leon RD, Hodgson JA, Roy RR, Edgerton VR. Retention of hindlimb stepping ability in adult spinal cats after the cessation of step training. J Neurophysiol. 1999;81:85–94.
,
Retention of hindlimb stepping ability in adult spinal cats after the cessation of step training
, J Neurophysiol
, vol. 81
(pg. 85
-94
) Barbeau H. Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair. 2003;17(1):3–11.
,
Locomotor training in neurorehabilitation: emerging rehabilitation concepts
, Neurorehabil Neural Repair
, vol. 17
(pg. 3
-11
) Dobkin B, Apple D, Barbeau H, Basso M, Behrman A, Deforge D, et al., Spinal Cord Injury Locomotor Trial Group. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology. 2006;66(4):484–493.
,
Spinal Cord Injury Locomotor Trial Group. Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI
, Neurology
, vol. 66
(pg. 484
-493
) Hicks Al, Adams MM, Martin Ginis K, Giangregoria L, 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.
,
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
, vol. 43
(pg. 291
-298
) Behrman A, Lawless-Dixon A, Davis S, et al. Locomotor training progression and outcomes after incomplete spinal cord injury. Phys Ther. 2005;85(12):1356–1371.
,
Locomotor training progression and outcomes after incomplete spinal cord injury
, Phys Ther.
, vol. 85
(pg. 1356
-1371
) Tomas SL, Gorassini MA. Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury. J Neurophysiol. 2005;94(4):2844–2855.
,
Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury
, J Neurophysiol
, vol. 94
(pg. 2844
-2855
) Behrman A, Harkema S. Locomotor training after human spinal cord injury: a series of case studies. Phys Ther. 2000;80(7):688–700.
,
Locomotor training after human spinal cord injury: a series of case studies
, Phys Ther.
, vol. 80
(pg. 688
-700
) Wirz M, Colombo G, Dietz V. Long term effects of locomotor training in spinal humans. J Neurol Neurosurg Psychiatry. 2001;71:93–96.
,
Long term effects of locomotor training in spinal humans
, J Neurol Neurosurg Psychiatry
, vol. 71
(pg. 93
-96
) Wernig A, Nanassy A, Muller S. Maintenance of locomotor abilities following Laufband (treadmill) therapy in para and tetraplegic persons: follow-up studies. Spinal Cord. 1998; 36(11):744–749.
,
Maintenance of locomotor abilities following Laufband (treadmill) therapy in para and tetraplegic persons: follow-up studies
, Spinal Cord
, vol. 36
(pg. 744
-749
) Wernig A, Muller S, Nanassy A, Cagol E. Laufband therapy based on “rules of spinal locomotion” is effective in spinal cord injured persons. Eur J Neurosci. 1995;7(6):1429.
,
Laufband therapy based on “rules of spinal locomotion” is effective in spinal cord injured persons
, Eur J Neurosci.
, vol. 7
pg. 1429
Wernig A, Nanassy A, Muller S. Laufband (treadmill) therapy in incomplete paraplegia and tetraplegia. Neurotrauma. 1999;16(8):719–726.
,
Laufband (treadmill) therapy in incomplete paraplegia and tetraplegia
, Neurotrauma
, vol. 16
(pg. 719
-726
) Wernig A, Muller S. Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries. Paraplegia. 1992;30(4):229–238.
,
Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries
, Paraplegia
, vol. 30
(pg. 229
-238
) Carvalho Dc, de Cassia Zanchetta M, Sereni JM, Cliquet A. Metabolic and cardiorespiratory responses of tetraplegic subjects during treadmill walking using neuromuscular electrical stimulation and partial body weight support. Spinal Cord. 2005;43(7):400–405.
,
Metabolic and cardiorespiratory responses of tetraplegic subjects during treadmill walking using neuromuscular electrical stimulation and partial body weight support
, Spinal Cord
, vol. 43
(pg. 400
-405
) Field-Fote EC, Tepavac D. Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation. Phys Ther. 2002;82(7):707–715.
,
Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation
, Phys Ther.
, vol. 82
(pg. 707
-715
) 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.
,
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
, vol. 31
(pg. 283
-291
) Effing TW, van Meeteren NL, van Asbeck FW, Prevo AJ. Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life. Spinal Cord. 2006;44(5):287–296.
,
Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life
, Spinal Cord
, vol. 44
(pg. 287
-296
) Israel JF, Campbell DD, Kahn JH, Hornby TG. Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury. Phys Ther. 2006;86(11):1466–1478.
,
Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury
, Phys Ther.
, vol. 86
(pg. 1466
-1478
) Field-Fote EC, Lindley SD, Sherma 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.
,
Locomotor training approaches for individuals with spinal cord injury: a preliminary report of walking-related outcomes
, J Neurol Phys Ther.
, vol. 29
(pg. 127
-137
) Field-Fote E. Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. Arch Phys Med Rehabil. 2000;82(6):818–824.
,
Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury
, Arch Phys Med Rehabil
, vol. 82
(pg. 818
-824
) Granat MH, Ferguson AC, Andrews BJ, Delargy M. The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury‐‐observed benefits during gait studies. Paraplegia. 1993;31(4):207–215.
,
The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury‐‐observed benefits during gait studies
, Paraplegia
, vol. 31
(pg. 207
-215
) American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury (revised). Chicago: ASIA; 2000:1–23.
Benz E, Hornby T, Bode R, Scheidt R, Schmit B. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil. 2005;86(1):52–59.
,
A physiologically based clinical measure for spastic reflexes in spinal cord injury
, Arch Phys Med Rehabil
, vol. 86
(pg. 52
-59
) Bolliger M, Lünenburger L, Bircher S, Colombo G, Dietz V. Robot-assisted assessment of isometric peak torque: mechanical and clinical reliability. In: Program and abstracts of the American Spinal Injury Association Annual Meeting, 2006.
Gregory CM, Bowden MG, Jayaraman A, et al. Resistance training and locomotor recovery after incomplete spinal cord injury: a case series. Spinal Cord. 2007;45(7):522–530.
,
Resistance training and locomotor recovery after incomplete spinal cord injury: a case series
, Spinal Cord
, vol. 45
(pg. 522
-530
) Perez MA, Field-Fote EC, Floeter MK. Patterned sensory stimulation induces plasticity in reciprocal Ia inhibition in humans. J Neurosci. 2003;23(6):2014–2018.
,
Patterned sensory stimulation induces plasticity in reciprocal Ia inhibition in humans
, J Neurosci.
, vol. 23
(pg. 2014
-2018
) Ladouceur M, Barbeau H. Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries: changes in kinematics and physiological cost of overground walking. J Rehabil Med. 2000;32(2):72–79.
,
Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries: changes in kinematics and physiological cost of overground walking
, J Rehabil Med.
, vol. 32
(pg. 72
-79
)
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