HANDLING OF THE PATIENTS. SPECIFIC DISEASES

Brain damaged persons

We have over the years been treating hemi - and tetraparetic as well as ataxic BDP patients. The most prevailing experience is that each patient has to be tried whether or not he can profit from LB therapy. For operational reasons we may dissociate two groups of patients: Patients with and patients without voluntary limb movement.

4.5.1 Patients without active lower limb movements: The therapeutic effect of patients passively moving on the laufband is to apply strong awakening effects (stronger than standing). Apart from that trophic effects on circulation, bone and muscles may be discussed.

4.5.2 Patients with (some) active limb movements: Therapeutic goal depends strongly on the patients capability and thus reaches from learning free/aided standing to aided/free walking. For all these patients the help given by the therapists is the same described above for hemiplegics.

4.5.3 Ataxia: We are still in an experimental stage trying different approaches. with ataxic patients. The rigid suspension system (without significant body weight support) and the crossed rubber bands are obvious supports for postural control during walking. The therapist verbally reminds the patient to actively control limb movement (which often is successful on the Laufband) and may hold back the ataxic limb during swing. For less handicaped patients, sessions of reduced help are included: Remove crossed rubber bands, have patient hold one holm of the frame only or do not allow the use of arms at all a.s.o.. Secured walking on the laufband without visual feedback control (closed eyes) with and without arm support might challenge and force training of the proprioceptive system as well as other compensatory mechanisms. In most cases it has not been possible yet to transfer successful corrections achieved on the laufband to walking over ground to a satisfactory degree, obviously the time span of a few weeks is not sufficient in these cases and longer periods on an outpatient basis are currently investigated.

Brain damaged patients who dont reach stepping capabilities within the first major attempt (during postacute or later hospitalization) might still try on a regular basis (e.g. once a week) or during one longer period (weeks with daily training) per year. This could be done in their domestic surrounding with trained outdoor therapists or in local facilities. Obviously with such severe deficits a single period of therapy is bound to be less effective. A similar case should be made with severe tetraplegics who have barely reached some locomotor capability during the first postacute rehabilitation or have arm paralyses hindering the use of canes or other devices: Since continual exercise of upright walking is the best therapy, and they cannot do it over ground independently, regular access to a treadmill (daily or intermittently, see above) have shown to be helpful (Hicks et al., 2005).