SELECTION OF PATIENTS

Hemiplegia:

As with SCI patients our strategy is to focus on non-ambulating hemiplegics, pushers and neglect patients and try to help them become independent walkers or make them walk with help. Already ambulating hemiplegics might profit from LB therapy too, but the effective gain is bound to be less and might be achieved - though with somewhat higher efforts from therapists side - by intensive walking overground as well. This is different for the non-ambulating hemiplegics: The amount of effort needed for overground walking (number of therapists necessary to walk the patient, physical effort by the therapists, security of the procedure and the practicability of correcting severe deficits like pushing and neglect) is bound to be in-comparably higher than on the treadmill (assuming a suitable treadmill; but see above and Nilsson et al. 2001) with the securing suspension system and body weight support. Therefore, with LB therapy, more and especially more older patients will have access to training of walking and will thus benefit from the new paradigm in rehabilitation of locomotion: Activity related learning, i.e. to train upright walking as intensive as possible. On the other hand, LB therapy is no magic and the proper locomotor training can of course be done over ground - though with much more effort. In fact, one of our paraplegic patients who walks for some 40 meters over ground without help but has extremely little voluntary muscle activity in his lower limbs, has successfully trained himself over ground (Wernig&Müller, 1991; 1992). Interestingly, in recent controlled clinical trials which compare LB therapy with "conventional" physiotherapy or other approaches (eg Nilsson et al., 2001; Kosak et al., 2000), the control groups are made to perform intensive training of locomotion over ground with good success . Even then it appears that for non-ambulating hemiplegics LB therapy is still considerably more effective (Kosak et al., 2000). See also 7.1.3

In times of reduced allowance for rehabilitation efforts it will be deciding how much can be achieved in the shortest possible period of time with the lowest possible amount of man power.

A recent study (Copenhagen Stroke Study) shows that regaining of walking under conventional physiotherapy either occurs early, within weeks after the event or hardly ever again (Jorgensen et al., 1995). We too see remarkable improvements within short periods of time under LB therapy even with severely paralyzed hemiplegics; however, also with chronic patients we would try and see what happens within a few sessions …..

There is converging information from several clinics including our own that with LB therapy we might have a break through with the severely paralyzed non-ambulating hemiparetic patients.

One might argue that severely paralyzed hemiplegics (or any other person with severe locomotor deficits) are better off in the wheel chair rather than walking for some distance with or without help from other persons. We feel that alone the easier handling of patients who can leave the wheel chair, be it only for a few steps or for standing up, makes the effort worth while. In addition we may assume positive effects on circulation, muscles and bones and prevention of skin ulceration. And we have seen how much it may mean to individuals to be capable of being upright and perform steps.

Thus, as long as other criteria are not available, all hemiparetic persons non-ambulating, acute and chronic might be tried with LB therapy, much can be seen within a few sessions already.