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BODY WEIGHT SUPPORT

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Locomotor Training

 

What is it?

Locomotor training is a form of activity based therapy that focuses on retraining the nervous system by driving neural plasticity by task specific training; specifically with step retraining on a body weight support system over a treadmill. This retraining is driven by the appropriate sensory cues to the spinal cord. The sensory cues are essentially the language of the nervous system. So, to create a clear picture of what the body is to learn the sensory cues must be very specific and correct to the recovery of the specific task.

4 Principles that Drive Recovery

  1. Maximize weight bearing on legs

  • increasing load bearing on the legs and reducing load

       bearing on the arms has been shown to increase the muscle activity of the legs

   2. Optimize sensory Cues

  • sensory cues range from hand placement during treadmill training to speed of walking, step length, foot placement and how much body weight is supported.

  • higher speeds of walking have been shown to improve walking outcomes

   3. Optimize Kinematics

  • essentially posture of walking and how the legs move.

  • the goal is to replicate a perfect walking pattern

   4. Maximize recovery strategies; minimize compensation strategies

  • recovery strategies promote the nervous system to recovery to its highest potential

  • compensation strategies limit recovery due to the lack of appropriate sensory cues or ones that are inconsistent with recovery

3 Components to Locomotor Training Program

  1. Step Training

  • body weight support treadmill walking, utilizing the litegait and gaitkeeper treadmill to simulate walking at a normal pace.

  • the goal is to retrain individuals to stand and step by utilizing the intrinsic mechanisms of the nervous system that produce neuromuscular activity

  • During step training, sensory information from the legs and trunk is repetitively sent to the spinal cord. The sensory input comes from the actual stepping, from the manual contact of the trainers on the participants and from the contact of the sole of the foot on the ground.

    2. Overground Assessment

  • the goal is to understand individual capabilities outside of body weight support environment

    3. Community Integration

  • the goal is to translate the stepping and neuromuscular capacity gained by retraining of the nervous system during step retraining into the home and community environments.

What Makes It Different Than Other Therapy? 

Not all treadmill training is the same. Locomotor Training is delivered in a systematic and standardized way across all NeuroRecovery Network centers. Locomotor training is very specific about hand placement and cuing to assist the nervous system in maximal recovery. Locomotor training is all about recovery and minimizing compensation. 

This program is driven by evidence-based research on activity dependent plasticity (the changes in the nervous or muscular systems that are driven by repetitive activity).

Why Are Central Generator Patterns Important?

Central pattern generators (CPGs) are responsible for rhythmic movement, excitatory and inhibitory connections that can generate complex patterns. Interneurons network to create CPGs. A large part of muscle activity needed to walk is located within the spinal cord via CPGs.

Networks of CNS interneurons that maintain the spontaneous repetitive activity rhythmic movements such as walking or running. They have the ability to sustain rhythmic movement without continued sensory input. CPGs are not fully understood but we know they play a critical role in locomotion having the ability to produce oscillatory motor output in the absence of any oscillatory input and without input from higher processing centres. Another discovery was that CPGs can modulate movement, through influencing flexor and extensor motor pools leading to interlimb coordination. 

With respect to spinal cord injury central pattern generators are a critical tool when utilized to its potential.  

*All connections between peripheral afferents and CNS neurons are excitatory (1st terminal) which must be balanced by CNS inhibition, mediated within the spinal cord by neurotransmitters or in higher processing centres. What this means is that all the sensory information received by the legs or arms from the outside is getting to the spinal cord whether an individual has sensation or not.

The Benefits of Locomotor Training

A few of the benefits that are associated with locomotor training are:

  • Improved quality of life

  • Improved circulation

  • Improved healing

  • Changes to bladder and bowel function

  • Improved cardiovascular health

  • Improved motor function

The ultimate goal of locomotor training is for clients to achieve independent mobility and walking in the home and community and to improve their health and quality-of-life after neurologic injury by inducing recovery of function. Walking is a complex task composed of stepping movements, balance (postural control/dynamic stability), and response to environmental demands.

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