PRINCIPLES
OF LAUFBAND (LB) THERAPY FOR SPINAL CORD DAMAGED PERSONS.
A.
Wernig, S. Müller
Department of Physiology,
Laufband therapy was developed in the late
80ies independently by two groups of researchers (1,2).
The principles had
previously been worked out in the spinal cat,
some decades ago, others only
recently. „Spinal locomotion“ was already noticed by Freusberg 1874.
Why its significance for the human was not noticed before, is not clear;
possibly the fact that “spinal man” does
not walk as a spinal cat does,
blurred the view at severely though incompletely paralyzed patients.
Today we interpret the surplus in evokable muscle activity during locomotion
versus resting positions as
instrumented by spinal locomotor centers fed with proprioceptive
information. This view is supported by the finding that “rules of spinal
locomotion” facilitate stepping in the (incompletely paralyzed) human as well
Recent EMG recordings verify that muscles not evokable during single joint
attempts may become active during air stepping (i.e.multijoint) and much more
so during locomotion. Patients will be demonstrated on video films who learned to perform independent stepping over ground with
little voluntary muscle activities in resting positions.
In
order to better evaluate such phenomena a cumulated
muscle score (EU-Muscle) is
suggested (3) which summarizes functionally important rather than spinal
segments-characterizing muscles (as the
Functional Classes SCI
(EU Walking):
0 1 2 3 4 5
.
First, results of a 5-year study are reported in which
89 incompletely paralysed (44
chronic and 45 acute) patients who underwent LB-therapy, are compared with a
total of 64 patients treated
conventionally for comparable periods of time (median 10.5 weeks). LB-therapy achieved
significantly better results in all comparisons (Wernig et al.,
Europ.J.Neurosci.7,823-829, 1995). A number of chronically wheelchair-bound patients
(not capable of raising from the wheelchair or walking without help from other
persons) became independent and walked with help of a rollator or two canes for
distances of at least 100 meters. Most chronic patients not capable of stair
case walking learned to do so either by themselves or with help from another
person following Laufband therapy. Also acute
patients treated on the Laufband achieved better results than conventionally
treated patients.
The
results of a follow-up evaluation are reported, in which walking capability of
Laufband treated patients, immediately following therapy, is compared with that
after 1-4 years in domestic surrounding (Wernig et al., Spinal Cord 36, 744 –
749, 1998).
Summary: Locomotor training
on the Laufband focuses on intensive walking in upright position, facilitated
by body weight support via a harness, the moving band of the treadmill and
initial limb setting by two therapists if necessary. These principles are derived from
observations in spinal animals on activity-related "learning" of the
isolated spinal cord
and on the "rules of spinal locomotion" in lower vertebrates.
The noval approach to intensely train precisely that skill which needs to be
achieved (upright walking) allows to reach therapeutic
goals far beyond those possible by conventional physiotherapy. As a rule in
motor rehabilitation, therefore, each patient with some if little voluntary
muscle activity remaining, needs to be trained on the Laufband to find and
approach his individual limits of locomotion.
Practical obstacles for a successful application of Laufband therapy on
a broader scale at the time are the poor education of the therapists in
practical handling of the patients and in their imagination of the possible
therapeutic goals to be reached.