Interventions to Improve Function and Fitness Rehabilitation professionals are always looking for better therapies to improve function and fitness in chronic SCI. In order for rehabilitation professionals to embrace new treatments and insurance companies to pay for them, it is important to conduct studies to evaluate outcomes and establish the benefits of new therapies. Currently, Miami Project rehabilitation researchers are conducting studies in Body Weight Support (BWS) Gait Training, Functional Neuromuscular Stimulation (FNS), and Exercise Physiology.
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Body Weight Support Gait Training
 BWS gait training uses a harness around the torso of the person to partially support their weight over ground or over a treadmill. This is a new therapy that shows promise in SCI rehabilitation, but before therapists accept it as standard therapy, it must be fully tested.
The idea for BWS training came from laboratory animal studies that reveal that a network of nerve cells in the spinal cord known as the central pattern generator (CPG) is responsible for coordination for walking. Walking is an activity that requires extensive coordination of messages from the brain to the CPG. It is believed that the CPG helps to synchronize the activation of muscles during the alternate movements of stepping.
At The Miami Project, BWS gait training is currently being tested in spinal cord injured volunteers who already demonstrate some voluntary movement in their legs. Researchers are interested in determining if BWS training helps to retrain spinal cord nerve circuitry and whether this rehabilitation intervention helps to improve their walking ability.
Recent results from the Miami Project show:
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Research volunteers have overall improvements in their lower extremity strength and in over-ground walking speed after BWS gait training. [Abstract]
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Researchers developed an assessment tool to evaluate the coordination of the legs during ambulation. Using this tool, they found that BWS training appears to improve limb coordination. These results suggest that improvements in walking are not only due to changes in strength and endurance, but may result from changes within the nervous system. [Abstract]
Functional Neuromuscular Stimulation (FNS)
Several studies conducted by Miami Project researchers evaluate the use of FNS. FNS uses electrodes to stimulate muscle contractions to produce movements in paralyzed or partially paralyzed muscles. The FNS armcrank ergometer, an exercise machine developed by Miami Project researchers, combines FNS and resistive exercise. This system has been evaluated to determine the effect of exercise on upper body strength, cardiopulmonary (heart and lung) function, the immune systems, and cholesterol levels in persons with weak arm function due to tetraplegia.
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| To view video of the Parastep®1 system, click here. For further information about obtaining the device and the location of training centers, see www.sigmedics.com |
Researchers have also evaluate assisted-walking devices in paraplegic subjects. In the 1990's, studies were undertaken to determine the effects of a walking system, Parastep®1, that combines FNS and controls on a special walker to allow paraplegic individuals to stand and take steps. The Parastep®1 system, approved by the FDA in 1994, enables some paraplegic individuals to walk from a few feet up to a mile or more and . Later studies characterized the physical and psychological benefits of this walking system and in April 2003 the device was approved for reimbursement by Medicare.
Miami Project researchers continue to study FNS walking systems and are currently evaluating newer programmable FNS devices.
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Researchers have proven there are beneficial cardiovascular benefits of assisted walking exercise. Study results indicate that, while FNS walking does not significantly improve bone density, it does improve upper extremity endurance and provides some psychological benefits. [Abstracts]
Exercise Physiology
 A goal of the Miami Project's Human Performance Laboratory is to evaluate methods to strengthen and protect the muscles of people with SCI. Another goal is to determine what exercises and activities optimize long-term health and fitness. A majority of people with SCI do not have access to FNS exercise devices or programs but may have access to exercise equipment in public facilities. Researchers examine the effect of voluntary circuit weight training exercises of the upper extremities in paraplegics and tetraplegics using equipment that can be found in most health clubs. In circuit weight training, research volunteers perform a series ("circuit") of upper extremity weight lifting and arm-crank exercises. To determine the benefits of this type of training program, investigators measure strength, cardiovascular function, and immune responses.
From their most recent results:
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Circuit resistance training, which combines weight lifting and armcrank ergometry, provides an exercise intensity adequate for cardiorespiratory benefits by safely and effectively improving muscle strength and endurance in paraplegics. [Abstract]
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Circuit resistance training results in a decline of the levels of HDL-cholesterol to a more desirable level, which could mean a 25% reduction in the risk for cardiovascular disease. [Abstract]
Miami Project Faculty working in this area of study
Edelle Field-Fote
Mark S. Nash
Other articles related to this topic
Director's Summaries
Measuring Fitness in People with Spinal Cord Injury
Determining the Benefits of Lower Extremity Exercise
Body Weight Support Training
Secondary Complications of SCI
Improving Walking
Exercise for Health Maintenance
Spinal Cord Control of Walking
Stimulation of Weak Muscles
Research Reviews
Summer 2003: Medicare to Pay for Parastep Walking System
Spring 2000: Do the Locomotion...Training the Spinal Cord to Improve Gait
Winter 1998: Strategies and Technologies to Restore Function and Fitness
Summer 1996: Stimulating Research Aims at Improving Arm Function After Cervical SCI |
