EQUIPMENT FOR LB THERAPY

The frame (3 in Fig 1).

The frame needs to be adjustable in height to comfort patients with different body sizes. There need to be three horizontal rods, one to each side and one in front. It is important that the vertical poles are not in the therapists way when working limbs of the patients. Rod diameters need to be suitable also for tetraplegics with little hand and finger functions, 4 cm to 5.5 cm diameter have been found practical.

Patients need to use the frame for balancing with help of their arms and initially most patients cannot do without. However, pulling and thus transferring body weight onto the frame is strongly discouraged, since it provides additional help and might prevent full loading of the limb. There are therapists who - to avoid this help - do not allow the patient to touch the frame at all; however, they need to have an extra therapist to give additional help for controlling posture and the lateral swing from the back.

Fig. 1
Schematic representation of equipment and principles of Laufband (LB) therapy. 1: Suspension system, 2: Harness, 3: Frame allowing use of arms for balance but not body weight support, 4: Knee is extended to allow full loading during stance phase, 5: Moving belt of treadmill (0.1 - some 4.0 kmh).

However, only few institutions if any can afford to have three therapists working on a patient simultaneously and it has not been shown to be as effective or even more effective than the patient using his arms.(see below).

The frame needs to be constructed in a way to allow mounting of additional supporting devices for the patients. We found a simple but very effective device, two rubber bands, one in front one at the patient`s back, crossing on both sides. A disadvantage of bands is that they hinder arm swing; however, when arm swing is being attempted towards the end or at advanced stages of LB therapy, the bands usually are not in use any longer. It is important to have them in the correct height, running across mid pelvis. This is one reason why the frame must be adjustable in height. Don't put the bands into the lumbar lordosis (you will enhance lordosis) or below the pelvis (the patients will sit on it). You will be surprised how much stability you add to your patient when properly mounted. (For this reason with improvement of the patient, the bands eventually need to be taken away in the course of LB therapy.)