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General description Generally speaking, it can be said that the human brain controls the motor actions of the body. But it does so not solely, as recent studies have shown. Also the spinal cord proves to have maintained the capability of controlling and evoking certain basic motor patterns e.g. of the lower limbs - a capability not readily recognizable under "normal" circumstances. In case of spinal injury - provided that the cord remains to some, however small extent connected to the brain - these programs may - driven by information from the limbs - contribute to stepping . Thus limbs need to be set correctly - even when initially set passively by therapist - and all this needs to be trained for weeks, agressively. If one wants to walk again, upright walking needs to be trained. The nervous system can learn, also the spinal cord can learn. It knows rules, the "rules of spinal locomotion". |
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The Laufband (treadmill) Therapy
And it is exactly thiese capabilities of the spinal cord that the Laufband (LB) Therapy is primarily based on. By the way, LAUFBAND is another German name for Tretmühle/treadmill, which sounds more appropriate than treadmill in connection with training patients. The idea is to teach the part of spinal cord below the point of injury to take as much control as possible of the affected region and to possibly rearrange remaining voluntary activity.
During LB Therapy this is achieved in various series of trainings that at first consist basically in walking upright on a motor driven treadmill . The patients´ weight is supported during these trainings by a special harness suspending from the ceiling, and initially they are aided by the therapists. Naturally the therapists need to be highly trained to understand and properly apply the "rules of spinal locomtion" (In German speaking countries and soon in USA courses for therapists are offered). Thus the spinal cord is provided with "information" from the limb muscles (such as load, direction, speed etc.) and prompted to react to them. And it learns to react to it, not in all but in considerable numbers of patients, by fitting in the missing "information", by completing the same movement it was prompted by. Then the cycle starts again: stimulated by movement the spinal cord generates new movement.
Unlike in training lower vertebrates, it has proven crucial to the effect of LB Therapy that there is some amount of voluntary motor ability left in the affected limbs. Naturally the more the better. From a practical point of view it is usually necessary to have at least some voluntary knee extension.