How Locomotor Training works
Significant advances have been made in our understanding of how the brain and spinal cord are wired and their capacity to rewire after injury and disease as a result of activity-based therapies. As a result of this new knowledge, new rehabilitation strategies have emerged, among them Locomotor Training (LT) which is used for people with brain and spinal cord injury (SCI), stroke and other neurological disorders. Many people with SCI, regardless of time elapsed since their injury, have improved their walking after receiving Locomotor Training in research programs and clinics in Germany, Canada, Switzerland, and the United States. Although it is not widely available in clinics in the United States, it is standard therapy for people with an incomplete SCI in Germany, Norway and Switzerland.
Presently, the Reeve Foundation’s NeuroRecovery Network (NRN) is deploying LT to spinal cord injured patients with incomplete cervical or thoracic injuries who have some movement or muscle tone in their legs.
Although no two patients respond to the therapy in exactly the same way, all NRN patients experience change as a result of LT. These changes can include improved recovery of independent walking and/or improvements in overall health and well-being. For some, health improvements can include better cardiovascular and pulmonary function, increased bone density, decreased spasticity, a decrease in the likelihood of skin lesions and improved glucose intolerance.
The way in which the NRN delivers Locomotor Training is based on current knowledge of how the brain and spinal cord control stepping and how the nervous system learns a motor skill. LT is delivered in a systematic and standardized way across all NRN centers using three primary component parts:
During the first phase, sensory information from the legs and trunk during walking is repetitively sent to the spinal cord using BWST. The sensory input comes from the actual stepping, from the manual contact of the therapist on the patient and from the contact of the sole of the foot on the ground. The therapist ensures that the patient is optimizing standing and walking although as the patient improves, the assistance of the therapist is reduced.
The same training principles used in Step Training, and the skills acquired by the patient, are then transferred to the Over-Ground Walking, and Community Ambulation phases. Locomotor Training consists of a continuum of training principles that are applied across the three training environments.