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LOCOMOTOR GAIT TRAINING LOCOMOTOR GAIT TRAINING
Treadmill or Locomotor Gait Training, also known as Weight-Supported Ambulation
Locomotor gait training is a rehabilitation approach that has been emerging over the last decade. It involves a kind of activity-triggered learning whereby practicing a series of specific movements (in this case, stepping) triggers the sensory information that somehow reminds the spinal cord how to initiate stepping.
Treadmill training uses repetitive motion to teach the legs how to walk again. A paralyzed person is suspended in a harness above a treadmill; this reduces the weight the legs will have to bear. As the treadmill begins to move, therapists move the person’s legs in a walking pattern. The theory that drives the work is that paralysis causes “learned non-use” of muscles. But the injured nervous system may be “plastic,” that is, capable of recovery when certain conditions, including the patterned neural activity that accompanies treadmill walking, are optimized.
Research from the University of California at Los Angeles and in Germany, Switzerland and Canada, notes that the spinal cord itself appears to act like a small brain and is thus capable of controlling ambulation. The spinal cord makes many routine decisions about the correct way to walk. When a paralyzed person is retrained to walk, both the brain and spinal cord figure out new ways to do it.
Many people with paralysis, regardless of time elapsed since onset, have improved their walking after receiving locomotor gait training. The level of recovery is different for each person, although almost all those with incomplete injuries showed gains.
It is important to understand, however, that locomotor gait training is an evolving procedure and may not help everyone to walk better. Scientists, physicians and therapists are still learning the best way to train and which patients can benefit the most. While locomotor training is part of the rehab experience for many Europeans, there is little expertise on how to do it and it is not widely available in the U.S. This is due to change soon as the commercialization of the technology moves forward.
As treadmill units filter out into the community, it is important for people to recognize that a locomotor gait training program must include highly trained therapists to work with patients. Maximizing a patient’s ability to step after injury depends to a very large extent on the skill and precision with which the therapists deliver locomotor gait training.
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