Gait Harness Research

Research Proves; Walking Helps Your Health

Research confirms systemic body benefits resulting from being able to stand and walk again over-ground, and the importance of avoiding negative learned non-use patterns and compensatory behaviors.

Second Step Gait Harness System over-ground standing and walking frame products are used world-wide in a broad spectrum of outpatient, inpatient, and home enriched environments. Clients can use the GHS at home as to enhance therapy they may be receiving in the clinic.

The System is a necessary tool to facilitate an aggressive, but controlled, approach to stimulating the neuromuscular, cardiovascular, and musculoskeletal systems over-ground. Improving step length symmetry through over-ground gait training has the potential to decrease fall risk, and provides a more “normal” walking pattern.

The GHS puts patients and their families back into a real-world environment. If the patient gets tired, they can just lean back in the Gait Harness and take a standing rest break, then go again.

The Gait Harness System also creates a functional environment for combined use with electric stimulation units, long leg bracing and prosthetics for the client learning to stand and walk again.

The GHS provides a chance for individuals with a variety of neurological and musculoskeletal illnesses or injuries to restore a sense of independence and normalcy to their lives, in a safe manner, without fear of falling. The System has been especially useful for hemiplegic participants who have very poor balance and are therefore at high risk for falls.

User say they feel comfortable and safe with the Gait Harness System, because they are better able to focus on regaining the skills of standing and walking again, rather than simply not falling.

Research below confirms that body weight support treadmill training (BWSTT), which relies on total guidance of the robotics, leaves little room for active effort on the part of the client, a key aspect in motor learning and functional gains, and is not preferable to progressive, over-ground therapy (OGT).

Studies also show that walking on a treadmill does not carry over well to over-ground walking. The active motor requirements in over-ground walking appear to be an important factor for promoting spatial symmetry in gait.

PROGRESSION OF AMBULATION IN A PERSON WITH INCOMPLETE PARAPLEGIA USING AN OVERGROUND HARNESS SUPPORT FRAME

Camacho MA, House MJ, Shields RK. University of Iowa Hospitals and Clinics and the University of Iowa Graduate Program of Physical Therapy and Rehabilitation Science, poster presented at APTA CSM 2003

PURPOSE: This case report describes a novel over ground gait training system that was used to facilitate functional ambulation in a person with incomplete spinal cord injury.

SUBJECT: The subject was a 22-year old female who sustained an incomplete spinal cord injury eleven months prior to initiation of outpatient therapy. The spinal cord was injured at the fourth thoracic level and caused residual diminished strength, proprioception, light-touch senses below the level of injury and absent pain and temperature senses. The American Spinal Cord Injury Association (ASIA) functional score was graded as C. The subject was on a prescription medication to manage spasticity of the lower extremities. The patient also reported her gait had remained the same over the last several months.

METHODS: The subject received physical therapy services for an hour and a half 3 times per week for 6 weeks. The primary intervention was supported gait training provided by the Second Step ™ system, which consisted of a wheeled frame with harness support for over-ground walking. Other interventions included lower extremity stretching and strengthening exercises. Pre-treatment and post-treatment measures were (1) 50-foot walk speed (2) Sit to stand height from a high/low mat with use of standard walker and one hand support on walker, (3) level of assistance needed for gait, and (3) a modified Quality of Life SF-12 Questionnaire (Shields 2002).

ANALYSIS: The percentage change in walking speeds, ability to rise from a chair, level of assistance, and the modified SF-12 scores was calculated before and after 6 weeks of the supported walking program

RESULTS: The subject demonstrated a 62 % decrease in the 50-foot walk speed from 170-seconds to 65-seconds following the training with the over ground harness system and required 20 % less assistance. The subject’s ability to rise from a progressively lower seated position improved by 16% from 25 inches to 21 inches. The patient’s perception of health quality remained over this 6-week time.

CONCLUSION: This subject demonstrated improvement in gait velocity, assistance needed, and ability to rise from a seated position after using the Second Step ™ gait training device. However, the improved walking did not reach a threshold to cause an improved perception of health quality.

RELEVANCE: Use of a gait training device, such as the Second Step ™, provided an individual with incomplete spinal cord injury the opportunity to walk with partial support of body weight without utilizing the more expensive suspended treadmill systems. Over-ground walking with this device may be facilitating the use of Central Pattern Generators for improved reciprocal gait ability. The results of this study have important practical and economic implications for the therapist designing a rehabilitation program for individuals with SCI.

Dr. Richard K. Shields PT, PhD

Chair of the Department of Physical Therapy and Rehabilitation Sciences at the University of Iowa Carver College of Medicine; Researcher & Professor; Director of Human Movement Control/Performance Laboratory; Member of the Board of Trustees for the Foundation for Physical Therapy.

Body weight-supported treadmill training versus conventional gait training for people with chronic traumatic brain injury.

Tracy H. Brown, PT; Julie Mount, PhD, PT; Bethany L. Rouland, PT; Katherine A. Kautz, MS, PT; Renee M. Barnes, PTA; Jihye Kim, MPT

J Head Trauma Rehabil. 2005 Sep-Oct;20(5):402-15.

OBJECTIVES:
To compare body weight support treadmill training (BWSTT) to conventional overground gait training (COGT).

CONCLUSIONS:

Physical therapy can improve gait for patients more than 6 years post-TBI. The COGT is more effective than the BWSTT for improving gait symmetry during overground walking.

Should Body Weight-Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate?

Bruce H. Dobkin, MD, and Pamela W. Duncan PT, PhD, FAPTA, FAHA

Neurorehabil Neural Repair. 2012 May;26(4):308-17. doi: 10.1177/1545968312439687. Epub 2012 Mar 12., https://www.ncbi.nlm.nih.gov/pubmed/22412172

CONCLUSION:

Body weight-supported treadmill training (BWSTT) and robotic-assisted step training (RAST) have not, so far, led to better outcomes than a comparable dose of progressive over-ground training (OGT) for disabled persons with stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, or cerebral palsy. BWSTT and RAST should not be provided routinely to disabled, vulnerable persons in place of OGT outside of a scientifically conducted efficacy trial.

Body-Weight-Supported Treadmill Rehabilitation after Stroke

Pamela W. Duncan , PT, PhD, FAPTA, FAHA; Katherine J. Sullivan, PT, PhD; Andrea L. Behrman, PT, PhD; Stanley P. Azen, PhD; Samuel S. Wu, PhD; Stephen E. Nadeau, MD; Bruce H Dobkin, MD; Dorian K. Rose, PT, PhD; Julie K. Tilson, DPT; Steven Cen, PhD; Sarah K. Kayden, BS for LEAPS Investigative Team

N Engl J Med 2011; 364:2026-2036 May 26, 2011DOI: 10.1056/NEJMoa1010790 http://www.nejm.org/doi/full/10.1056/NEJMoa1010790

BACKGROUND:

In stroke survivors living in the community with marked limitations in walking, task-specific step training that included treadmill training with body-weight support (locomotor training) was not shown to be superior in improving the functional level of walking to home-administered physical therapy focused on less-intensive but progressive strength and balance training. Locomotor training/ treadmill training with body-weight support was associated with a higher frequency of minor adverse events than was home exercise, and among participants with severe impairment at baseline, those in the early locomotor training group were more likely to have multiple falls than those in either of the other two groups. The locomotor-training interventions stressed stepping and walking and did not include progressive balance-specific training. At 1 year after stroke, our findings did not establish the superiority of locomotor training on a treadmill that included body-weight support over home-based physical therapy that emphasized strength and balance, regardless of whether locomotor training was started 2 or 6 months after the stroke. The home-exercise program had fewer risks and may be more feasible.

CONCLUSIONS:
Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist.

New evidence for therapies in stroke rehabilitation

Bruce H. Dobkin, MD and Andrew Dorsch, MD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679365/

CONCLUSION:

Most survivors of a stroke are left with chronic disability. Rehabilitation efforts during the initial three to six months after stroke should aim to maximize patients’ physical, communicative, and cognitive functioning. Continued improvement in the chronic phase of stroke can occur with regular, progressive skills practice of goal-directed tasks in the home.

Randomized Clinical Trial of Therapeutic Exercise in Subacute Stroke

Pamela Duncan, PhD, FAPTA; Stephanie Studenski, MD, MPH; Lorie Richards, PhD; Steven Gollub, MD; Sue Min Lai, PhD; Dean Reker, PhD; Subashan Perera, PhD; Joni Yates, MPH; Victoria Koch, MPH; Sally Rigler, MD, MPH; Dallas Johnson, PhD

http://stroke.ahajournals.org/content/strokeaha/34/9/2173.full.pdf

CONCLUSIONS:

This structured, progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance, balance, and mobility beyond those attributable to spontaneous recovery and usual care.

Revenge of the “Sit”: How Lifestyle Impacts Neuronal and Cognitive Health

Shoshanna Vaynman and Fernando Gomez-Pinilla

https://www.ibp.ucla.edu/research/GomezPinilla/publications/Exc699.pdf

CONCLUSION:

Lifestyle implementations such as exercise seem to inherently activate systems concerned with whole body metabolism and brain plasticity.

Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage.
Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, Binning MJ.

Phys Ther 2013;92(2):208-15

BACKGROUND:
Survivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications.

CONCLUSIONS:
The results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.

Walking is more like catching than tapping: gait in the elderly as a complex cognitive task.

Jeffrey M. Hausdorff MD, Galit Yogev, Shmuel Springer, Ely S. Simon, Nir Giladi, Division on Aging, Harvard Medical School

https://www.ncbi.nlm.nih.gov/pubmed/15864565

CONCLUSION:

findings underscore the interconnectedness of gait and cognitive function, indicate that even routine walking is a complex cognitive task that is associated with higher-level cognitive function.

Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.
Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, Lloyd JM, Waters C, Williams S.

Phys Ther 2013;92(2):197-207

BACKGROUND:
Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays.

CONCLUSION:
The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

Effects of gait training with body weight support on a treadmill versus overground in individuals with stroke.

Gama GL, Celestino ML, Barela JA, Forrester L, Whitall J, Barela AM. Arch Phys Med Rehabil. 2017;98(4):738-45. https://www.ncbi.nlm.nih.gov/labs/articles/28034719/

CONCLUSIONS:

Gait training over-ground is shown to be more effective and useful than gait training over a treadmill. Individuals with chronic stroke equally improve gait speed and other gait parameters after 18 sessions of BWS gait training on either a treadmill or over-ground. Only the over-ground group improved step length symmetry ratio, suggesting a role of integrating over-ground walking into BWS interventions post stroke.

Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions
date: 17 November 2015.
author: Paleg G., Livingstone R.
publication: BMC Musculoskeletal Disorders
PubMed ID: 26576548

BACKGROUND:
Sitting for more than 8 h a day has been shown to negatively impact health and mortality while standing is the recommended healthier alternative.

RESULTS:

Stronger evidence supports the impact of home-based supported standing programs on range of motion and activity, primarily for individuals with stroke or spinal cord injury.

CONCLUSIONS:
Standing should occur 30 min 5 times a week for a positive impact on most outcomes while 60 min daily is suggested for mental function and bone mineral density.

Follow-up assessment of standing mobility device users.
date: 10/01/1998
author: Dunn RB, Walter JS, Lucero Y, Weaver F, Langbein E, Fehr L, Johnson P, Riedy L.
publication: Assistive Technology. 1998;10(2):84-93.
pubmed_ID: 10339284

There was a favorable response on the effects of the standing devices on bowel regularity, reduction of urinary tract infections, leg spasticity, and number of bedsores. Finally, 79% of subjects highly recommended use of standing devices to other people with spinal cord injury. The positive responses of individuals using standing devices is a strong recommendation for the assistive technology community to make these devices more available to individuals with spinal cord injury.

The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke
date: 2008 Dec;39(12):3329-34
author: Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C, Dewey ME.
publication: Stroke
pubmed_ID:18787199 https://www.ncbi.nlm.nih.gov/pubmed/18787199

BACKGROUND AND PURPOSE:
Complications after stroke have been shown to impede rehabilitation, lead to poor functional outcome, and increase cost of care.

CONCLUSIONS:
Immobility-related complications are very common in the first year after a severely disabling stroke. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent.

Standing and mortality in a prospective cohort of Canadian adults.
date: 2014;46(5):940-6
author:Katzmarzyk PT
publication:Med Sci Sports Exerc.

pubmed_ID:24152707

CONCLUSIONS:

Given that mortality rates declined at higher levels of standing, standing may be a healthier alternative to excessive periods of sitting.

Sitting time and all-cause mortality risk in 222 497 Australian adults
date: 2012 Mar 26;172(6):494-500.
author: van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A.
publication:Arch Intern Med.
pubmed_ID:22450936

CONCLUSIONS:

Prolonged sitting is a risk factor for all-cause mortality, independent of physical activity. Public health programs should focus on reducing sitting time in addition to increasing physical activity levels.

Standing time and all-cause mortality in a large cohort of Australian adults.
date: 2014 Dec;69:187-91.
author: van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE
publication: Prev Med.
pubmed_ID:PMID:25456805

URL:https://www.ncbi.nlm.nih.gov/pubmed/25456805

CONCLUSION:
This study showed a dose-response association between standing time and all-cause mortality in Australian adults aged 45 years and older. Increasing standing may hold promise for alleviating the health risks of prolonged sitting.

Systematic review of the health benefits of physical activity and fitness in school-aged children and youth.
date: 2010 May 11;7:40.
author: Janssen I, Leblanc AG.
publication: Int J Behav Nutr Phys Act.
pubmed_ID: 20459784

RESULTS:

Physical activity was associated with numerous health benefits. Studies indicate that the more physical activity, the greater the health benefit. Results from experimental studies indicate that even modest amounts of physical activity can have health benefits in high-risk youngsters. To achieve substantive health benefits, the physical activity should be of at least a moderate intensity. Vigorous intensity activities may provide even greater benefit. Aerobic-based activities had the greatest health benefit, other than for bone health, in which case high-impact weight bearing activities were required.

CONCLUSION:
The following recommendations were made: 1) Children and youth 5-17 years of age should accumulate an average of at least 60 minutes per day and up to several hours of at least moderate intensity physical activity. Some of the health benefits can be achieved through an average of 30 minutes per day. 2) More vigorous intensity activities should be incorporated or added when possible, including activities that strengthen muscle and bone 3) Aerobic activities should make up the majority of the physical activity. Muscle and bone strengthening activities should be incorporated on at least 3 days of the week.

Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home.
date:2007 Jan;2(1):43-9.
author: Netz Y, Argov E, Burstin A, Brown R, Heyman SN, Dunsky A, Alexander NB.
publication: Disabil Rehabil Assit Technol

pubmed_ID:19263553

CONCLUSION:

A pilot program of physical activity using a Standing–Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement.

Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury.
date: 2007 Jun;86(6):499-506
author: Edwards LC, Layne CS.
publication: Am J Phys Med Rehabil
PubMed ID:17515690

RESULTS:
The results of this study indicate that the subjects actively responded to exercise during dynamic weight bearing (DWB).

CONCLUSIONS:
The results suggest that exercise during DWB can induce physiologic and neuromuscular responses in individuals who have a spinal cord injury, and that exercise during DWB may serve as a preparatory program for more advanced rehabilitation.

Does standing protect bone density in patients with chronic spinal cord injury?
date: 2008;31(2):197-201.
author: Goktepe A.
publication: J Spinal Cord Med.
PubMed ID:18581668

CONCLUSIONS:
Standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization

Bone mineral status in paraplegic patients who do or do not perform standing
date: 1994 May;4(3):138-43.
author: Goemaere S.
publication: Osteoporos Int.
PubMed ID:8069052

Results suggest that passive mechanical loading can have a beneficial effect on the preservation of bone mass in osteoporosis found in paraplegics.

Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography
date: 2000 Jan;38(1):26-32.
author: Frey-Rindova P.
publication: Spinal Cord.
PubMed ID:10762194

CONCLUSIONS:
In some subjects regular intensive loading exercise activity in early rehabilitation (tilt table, standing) can possibly attenuate the decrease of bone mineral density of tibia.

Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury.
date: 2007 Jun;86(6):499-506
author: Edwards LC, Layne CS.
publication: Am J Phys Med Rehabil
PubMed ID:17515690

​
CONCLUSIONS:
The results suggest that exercise during dynamic weight bearing (DWB) can induce physiologic and neuromuscular responses in individuals who have a spinal cord injury, and that exercise during DWB may serve as a preparatory program for more advanced rehabilitation.

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

date: 03/01/2005
author: Zabel, R J.; McMillan, A G.; Salem, Y
publication: Pediatric Physical Therapy:Volume 17(1)Spring 2005p 93

CONCLUSIONS:

Prolonged standing may improve gait in children with cerebral palsy.

Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury.
date: 06/01/2007
author: Edwards LC, Layne CS.
publication: Am J Phys Med Rehabil. 2007 Jun;86(6):499-506.
pubmed_ID: 17515690

CONCLUSIONS:

The results suggest that exercise during dynamic weight bearing can induce physiologic and neuromuscular responses in individuals who have a spinal cord injury, and that exercise during DWB may serve as a preparatory program for more advanced rehabilitation.

What is it like to walk with the help of a robot? Children’s perspectives on robotic gait training technology
Phelan S, Gibson B, Wright F.

http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1019648

CONCLUSIONS:

Children in this study did not consistently feel excited about, have a wish to use, or have a sustained interest in the use of Lokomat robotic technology, and at times experienced some anxiety in relation to their participation in the intervention. The children became bored after walking in the device. Notably, what the children valued above the actual therapy was the interaction between themselves and the therapists. This highlights the importance of human touch and relationships, important to remember as we evaluate the available interventions for gait training.

Brain activation during dual-task processing is associated with cardiorespiratory fitness and performance in older adults
https://doi.org/10.3389/fnagi.2015.00154

CONCLUSION:

Brain function associated with higher cardiorespiratory fitness plays a role in increased cognitive performance in older adults. Higher levels of fitness help increase volume in key regions of the brain and improve executive function, which plays a role in reasoning and problem solving. Higher levels of physical activity also led to increased levels of brain activity while doing multiple tasks.

Balance, Balance Confidence, and Health-Related Quality of Life in Persons With Chronic Stroke After Body Weight-Supported Treadmill Training

Stephanie A. Combs, PT, PhD; Eric L. Dugan, PhD; Miranda Passmore, DPT; Cara Riesner, DPT; Dana Whipker, DPT; Elizabeth Yingling, DPT; Amy B. Curtis, PhD

http://www.archives-pmr.org/article/S0003-9993(10)00762-8/abstract

CONCLUSION:

For most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.

Benefits of rehabilitation for traumatic spinal cord injury: a case report.
Lu AC, Yarkony GM.

https://www.ncbi.nlm.nih.gov/pubmed/8673509

CONCLUSION:

Case illustrates the effectiveness and importance of aggressive inpatient rehabilitation following spinal cord injury.

Neuroplasticity after spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery.

Andrea I. Behrman, Mark G. Bouden, Preeti M. Nair

Phys Ther. 2006 Oct;86(10):1406-25.

CONCLUSION:

Evidence from basic science demonstrates that the central nervous system after injury is malleable and can learn. The evidence is especially compelling concerning locomotion. evidence supporting an impending paradigm shift from compensation for deficits to rehabilitation as an agent for improving walking recovery should be pursued.

Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children with Cerebral Palsy: Systematic Review and Meta-analysis.

Moreau N, Bodkin AW, Bjornson K, Hobbs A, Soileau M et al.

Phys Ther. 2016;96(12):1938-54. https://www.ncbi.nlm.nih.gov/pubmed/27313240

CONCLUSIONS:

Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs

date: 2013 Fall;25(3):232-47
author: Paleg GS, Smith BA, Glickman LB.
publication: Pediatr Phys Ther.
PubMed ID: 23797394

CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE:
Standing programs 5 days per week positively affect bone mineral density (60 to 90 min/d); hip stability (60 min/d in 30° to 60° of total bilateral hip abduction); range of motion of hip, knee, and ankle (45 to 60 min/d); and spasticity (30 to 45 min/d).

Weight bearing through lower limbs in a standing frame with and without arm support and low-magnitude whole-body vibration in men and women with complete motor paraplegia

date: 2012 Apr;91(4):300-8. doi
author: Bernhardt KA
publication: Am J Phys Med Rehabil
PubMed ID:22407161

CONCLUSIONS:

Men and women with paraplegia using a standing frame bear most of their weight through their lower limbs. Supporting their arms on the tray reduces the GRF by approximately 10% body weight. Low-magnitude vibration provided additional oscillation of the load-bearing forces.

Does standing protect bone density in patients with chronic spinal cord injury?

date: 2008;31(2):197-201.
author: Goktepe A.
publication: J Spinal Cord Med.
PubMed ID:18581668

CONCLUSIONS:

Standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

Bone mineral status in paraplegic patients who do or do not perform standing

date: 1994 May;4(3):138-43.
author: Goemaere S.
publication: Osteoporos Int.
PubMed ID:8069052

Passive mechanical loading can have a beneficial effect on the preservation of bone mass in osteoporosis found in paraplegics.

Moving the arms to activate the legs.

date: 07/01/2006
author: Ferris DP, Huang HJ, Kao PC.
publication: Exerc Sport Sci Rev. 2006 Jul;34(3):113-20.
pubmed_ID: 16829738

Gait rehabilitation therapy after neurological injury should incorporate simultaneous upper limb and lower limb rhythmic exercise to take advantage of neural coupling.

Effect of prolonged bed rest on bone mineral.

date: 12/19/1970
author: Donaldson CL, Hulley SB, Vogel JM, Hattner RS, Bayers JH, McMillan DE.
publication: Metabolism. 1970 Dec; 19(12): 1071-84
pubmed_ID: 4321644
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/4321644

Bone mineral is lost during immobilization. This disuse osteopenia occurs locally in patients with fracture or hemiplegia and is generalized in quadriplegia.

Alternate leg movement amplifies locomotor-like muscle activity in spinal cord injured persons.

date: 02/01/2005
author: Kawashima N, Nozaki D, Abe MO, Akai M, Nakazawa K.
publication: J Neurophysiol. 2005 Feb;93(2):777-85. Epub 2004 Sep 22.
pubmed_ID: 15385590

Sensory information generated by alternate leg movements plays a substantial role in amplifying the induced locomotor-like muscle activity in the lower limbs.

Indications for a home standing program for individuals with spinal cord injury.

date: 09/01/1999
author: Walter JS, Sola PG, Sacks J, Lucero Y, Langbein E, Weaver F.
publication: J Spinal Cord Med. 1999 Fall;22(3):152-8.
pubmed_ID: 10685379

Respondents who stood 30 minutes or more per day had significantly improved quality of life, fewer bed sores, fewer bladder infections, improved bowel regularity, and improved ability to straighten their legs compared with those who stood less time. Compliance with regular home standing (at least once per week) was high (74%). The data also suggest that individuals with SCI could benefit from standing even if they were to begin several years after injury. The observation of patient benefits and high compliance rates suggest that mobile standing devices should be more strongly considered as a major intervention for relief from secondary medical complications and improvement in overall quality of life of individuals with SCI.

Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies

J Spinal Cord Med. 2006;29:489–500.

Lora Giangregorio, PhD And Neil McCartney, PhD

CONCLUSION:

Individuals with SCI not only lose motor and/or sensory function, they experience dramatic muscle and bone changes. Functional electrical stimulation is a method of exercise that has been employed in the SCI population that has demonstrated some success in improving muscle, with less conclusive evidence that it has a positive effect on bone.