Locomotor Training: Principles and Practice

Hardcover | June 27, 2011

bySusan Harkema, Andrea Behrman, Hugues Barbeau

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Physical rehabilitation for walking recovery after spinal cord injury is undergoing a paradigm shift. Therapy historically has focused on compensation for sensorimotor deficits after SCI using wheelchairs and bracing to achieve mobility. With locomotor training, the aim is to promote recoveryvia activation of the neuromuscular system below the level of the lesion. What basic scientists have shown us as the potential of the nervous system for plasticity, to learn, even after injury is being translated into a rehabilitation strategy by taking advantage of the intrinsic biology of thecentral nervous system. While spinal cord injury from basic and clinical perspectives was the gateway for developing locomotor training, its application has been extended to other populations with neurologic dysfunction resulting in loss of walking or walking disability.

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Physical rehabilitation for walking recovery after spinal cord injury is undergoing a paradigm shift. Therapy historically has focused on compensation for sensorimotor deficits after SCI using wheelchairs and bracing to achieve mobility. With locomotor training, the aim is to promote recoveryvia activation of the neuromuscular system b...

Dr. Susan J. Harkema PhD, Associate Professor holds the Owsley B. Frazier Rehabilitation Chair in Neurological Surgery and is the Rehabilitation Research Director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville. She is the Director of Research at Frazier Rehab Institute and is Director of the NeuroR...
Format:HardcoverDimensions:224 pages, 10 × 7 × 0.98 inPublished:June 27, 2011Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195342089

ISBN - 13:9780195342086

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Table of Contents

1. Evidence Based Practice and Activity Based Therapy for Recovery of Posture, Standing, and WalkingI. Rehabilitation of Walking after Neurologic Injury or Disease: A Historical PerspectiveII. Recovery of Posture and Walking following Spinal Cord Injury1. Functional deficits following spinal cord injury2. Compensatory rehabilitation after spinal cord injuryIII. Recovery of Posture and Walking following Stroke1. Functional deficits following stroke2. Rehabilitation after strokeIV. Evidence Based Practice1. Evidence-based, restorative strategies for rehabilitation after neurologic insult: Locomotor Training2. Scientific and Physiological Evidence for Locomotor TrainingI. Neural Control of Locomotiona. Central Pattern Generationb. Interaction of Sensory Input with Spinal Cord Interneuronal Networksc. Activity-dependent Plasticity; Task Specific RetrainingII. Evidence of Sensory Processing by Human Spinal NetworksIII. Translation of Scientific Evidence into a Rehabilitation Interventiona. Activity-Based Therapy (Locomotor Training)i. Maximize weight bearing on the legs (Principle 1)ii. Optimize sensory cues (Principle 2)iii. Optimize the kinematics (i.e. trunk, pelvis, and lower extremities) for each motor task (Principle 3)iv. Maximize recovery strategies, minimize compensation strategies (Principle 4)b. Clinical Evidence for Functional Recovery in Spinal Cord Injuryc. Clinical Evidence for Functional Recovery in Stroked. Severity of Locomotor Impairment3. Locomotor Training as an Activity-Based Therapy for Posture, Standing, and WalkingIV. Compensation Based Rehabilitation to Activity-Based Therapya. Compensation Approachesb. Activity-Based TherapyV. Locomotor Training Principlesa. Maximize Weight Bearing on the Legsb. Optimize Sensory Cues Appropriate for Specific Motor Taskc. Optimize Kinematics for each Motor Taskd. Maximize Recovery, Minimize CompensationVI. Locomotor Training Therapeutic Componentsa. Step Trainingb. Over Ground Assessmentc. Community IntegrationVII. Phases of Recoverya. Phase 1b. Phase 2c. Phase 3d. Phase 4VIII. Areas of Progressiona. Enduranceb. Speedc. Weight-Bearing (Load)d. IndependenceIX. Clinical Modela. Equipmentb. Staffingc. Clinical Guidelines4. Basic Skills for the Implementation of Locomotor TrainingI. Proper Attire, Harness Application, and Support Apparatusa. Proper Client Attireb. Applying the Harnessi. Pelvic Belt Placementii. Harness Vest Placementiii. Leg Strap Placementiv. Final Adjustments and Troubleshooting Harness Fitc. System Requirementsd. Positioning the Client on the BWSTII. Client and Trainer Positions during Standinga. Client Positionb. Hip Trainerc. Leg TrainersIII. Client and Trainer Positions during Steppinga. Client Positionb. Hip Trainerc. Leg Trainersd. Alternate Hand Placementsi. Reverse Hand Placementii. Modified Standard Hand Placement5. Basic Skills for Retraining the Nervous SystemI. Locomotor Training: The Step Training Componenta. Step Retrainingi. Weight bearingii. Appropriate Kinematicsiii. Appropriate Kineticsb. Step Adaptabilityi. Trunk Independenceii. Pelvis Independenceiii. Leg Independencec. Stand Retrainingi. Load Bearing of the Legsii. Appropriate Kinematicsiii. Appropriate Kineticsd. Stand Adaptabilityi. Trunk Stabilityii. Independent Pelvisiii. Leg Independenceiv. Sit to StandII. Team Rolesa. Clientb. Team Leaderc. Hip Trainerd. Leg Trainer(s)e. Body Weight Support Treadmill Operator6. Introduction to Over Ground Assessment and Community IntegrationI. Over Ground Assessmenta. Trunk Stabilityb. Sit to Standc. Standd. Initiating Walkingi. Upright Postureii. Weight Shifte. Optimal Walking PatternII. Community Integrationa. Introducing Assistive Devicesb. Trunk Stabilityc. Sit to Standd. Stande. Initiating Stepping and Good Stepping7. Phases of RecoveryI. Introduction to Four Phases of RecoveryII. Abilities during Step Traininga. Stand Retrainingb. Stand Adaptabilityc. Step Retrainingd. Step AdaptabilityIII. Abilities during Over Ground Assessmenta. Sitb. Reverse Sit Upc. Sit Upd. Trunk Extensione. Sit to Standf. Standg. WalkingIV. Goals by Phase of Recovery and Locomotor Training Componenta. Phase 1 Goalsi. Step Trainingii. Over Ground Assessmentiii. Community Integrationb. Phase 2 Goalsi. Step Trainingii. Over Ground Assessmentiii. Community Integrationc. Phase 3 Goalsi. Step Trainingii. Over Ground Assessmentiii. Community Integrationd. Phase 4 Goalsi. Step Trainingii. Over Ground Assessmentiii. Community IntegrationV. Appendixa. Phase Scoring Sheetb. Phase Sheet Cards8. Progression to RecoveryI. Introduction to Progressiona. Four areas of progressi. Enduranceii. Speediii. Loadiv. IndependenceII. Progression by Phase of Recovery and Locomotor Training Componenta. Phase 1 Progressioni. Step Trainingii. Over Ground Assessmentiii. Community Integrationb. Phase 2 Progressioni. Step Trainingii. Over Ground Assessmentiii. Community Integrationc. Phase 3 Progressioni. Step Trainingii. Over Ground Assessmentiii. Community Integrationd. Phase 4 Progressioni. Step Trainingii. Over Ground Assessmentiii. Community IntegrationIndex