Walk Again With Neurological Disorders
Recovery is Possible
Design Features & Benefits
Use the Gait Harness System to Walk Again with Neurological Disorders
People with nervous system disorders who walk live longer, live better, live healthier.
Neurological disorders are diseases of the brain, spine and the nerves that connect them. There are more than 600 diseases of the nervous system, such as brain tumors, multiple sclerosis, epilepsy, Parkinson’s disease and stroke as well as types of dementia.
In addition to drugs, an aerobic and weight-bearing exercise regimen can increase energy levels, reduce apathy and improve the overall sense of well-being. A personal trainer or caregiver can be helpful to ensure participation in an exercise program involving safe standing and walking again.
- Arteriovenous Malformation
- Brain Aneurysm
- Brain Tumors
- Dural Arteriovenous Fistulae
- Memory Disorders
- Multiple Sclerosis
- Parkinson’s Disease
- Peripheral Neuropathy
- Post-Herpetic Neuralgia
- Spinal Cord Tumor
Below we share information on neurological disorders most common to many of our clients who use the Second Step Gait Harness System in their homes as part of a long-term functional recovery: MS, Parkinson’s disease, stroke, and brain aneurysm.
About 400,000 Americans, mostly young adults, suffer from MS. It occurs almost twice as frequently among women than men.
Although there is no proven, long-term cure, most MS patients lead active lives for many years after their diagnosis and have a normal life span. But MS can be tiring and require schedule and lifestyle adjustments.
A regular exercise program that includes walking, swimming, stretching and/or riding a stationary bike can reduce some symptoms. Practitioners and caregivers can help the MS client learn to better cope with the condition by improving walking ability, balance, range of motion and stamina.
Multiple Sclerosis Signs and Symptoms
Likewise, damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination. MS patients can have a wide range of symptoms, depending on where the damage occurs in the central nervous system. Symptoms usually appear in people between 20 and 40 years of age.
Because MS can cause a wide variety of symptoms in different people, doctors frequently struggle to diagnose the disease. However, common symptoms of MS include changes in sensation or sensory symptoms such as tingling and numbness, and changes in muscle function or motor symptoms such as difficulty walking, stiffness or tremors.
Some common symptoms are:
- Clumsiness or weakness
- Difficulty walking or maintaining balance
- Dizziness or vertigo
- Eye problems such as double vision or uncontrolled eye movements
- Muscle spasms
- Problems with bladder or bowel control
- Tingling or numbness
- Depression or emotional charges
- Mild intellectual change such as memory problems
- Sexual problems
A neurology team, primary care physician, and physical therapist will typically design a treatment plan tailored to the patient’s medical condition, state of health and individual needs.
Medications may be prescribed to treat or control symptoms such as depression, fatigue, pain, spasticity and tremors. Treatment programs and services may include exercise and physical therapy, occupational therapy to help maintain independence in daily living, and stress reduction.
The disease, which affects about 1 million people in the United States, targets neurons that produce an important chemical called dopamine. Dopamine is a chemical messenger that transmits signals within the brain. Normally, dopamine operates in a delicate balance with other neurotransmitters to help coordinate the millions of nerve and muscle cells involved in movement. Because Parkinson’s patients have a loss of dopamine-producing cells in the brain, the coordination among nerve and muscle cells is disrupted.
Parkinson’s Disease Signs and Symptoms
Parkinson’s generally progresses slowly, sometimes taking years for symptoms to appear. The disease usually strikes adults over age 50, although it has been diagnosed as early as age 20. About 15 percent of PD patients have a family history of the disease.
Because it develops gradually, most people have many years of productive living after being diagnosed.
Some of the first symptoms commonly experienced with Parkinson’s include the following:
Rigidity — Arms and legs become stiff and hard to move
Tremors — Rapid shaking of the hands, arms or legs
Slowed movements — Difficulty starting or completing movements, called bradykinesia
Impaired balance — Lack of balance or difficulty adjusting to sudden changes in position
These symptoms may make it difficult for the PD patient to walk, pick up and hold things, eat, write, or react quickly to prevent injury if they fall.
Other symptoms include difficulty speaking or swallowing, drooling, stooped posture, inability to make facial expressions, oily skin, cramped handwriting, shortness of breath, constipation, increased sweating, erectile dysfunction, difficulty sleeping, problems urinating and anxiety. They also are often very hard to understand as their speech can run together and is often characteristically quiet. This affects communication with others.
People with Parkinson’s often have trouble getting started, whether it’s speaking or walking. Persons with PD have significant difficulties with mobility and movement.
Parkinson’s Disease Treatment
Medications can provide dramatic relief from Parkinson’s symptoms, but no drug has been found which can stop the progression of the disease. Drugs tend to be less effective over time. In some cases, surgery is an option.
Most doctors and practitioners recommend physical therapy and muscle strengthening. For many patients, a combination of medication management, physical therapy, and active weight-bearing movement and walking works best.
Complementary Treatments & Exercise
Complementary or integrative care combines the best of alternative therapies — such as acupuncture, massage, meditation, herbs and nutrition — and conventional medicine. Many treatments such as simple physical activity, physical therapy, massage and support groups can help relieve symptoms and improve quality of life.
Recent literature strongly suggests that exercise has a therapeutic benefit for people with Parkinson’s disease. In addition to deciding which type of exercise is appropriate, you may also wonder how intense the workout should be. There is growing evidence that vigorous exercise may have a neuroprotective effect for people with PD.
In addition, long-term regular physical activity, including walking, is associated with significantly better cognitive function and less cognitive decline in older women. Read study.
See Why walk post stroke? to learn why it is important to get up and walk again for stroke survivors.
Aneurysms have the potential to leak or rupture, causing bleeding into the brain or the surrounding area called the subarachnoid space. This subarachnoid hemorrhage can cause a stroke, leading to brain damage or death.
About 3 percent to 5 percent of the American population is affected by a brain aneurysm. The condition most commonly affects adults between the ages of 35 to 60 years old. Aneurysms affect women more frequently than men. They can develop from continuous wear and tear on the artery walls and can be caused by factors such as genetics, injury or infection.
Often, the devastating effects of aneurysm are not fully understood until after the patient has completed medical treatment in an ICU and has entered rehabilitation.
Long-term disability is a frequent sequel of aneurysm and takes the form of persisting motor impairments that impact walking and autonomous movement. To improve environmental negotiation and basic care skills, independent gait is an essential therapy goal for aneurysm patients.
For the neurologically affected client, learning to walk again should be a top priority.
See Why walk post stroke? to learn why it is important to get up and walk again for aneurysm survivors.
Walking After a Neurological Disorder: Recovery is Possible
Ambulation is a crucial component to lifetime health. Movement keeps joints lubricated and stimulates the survivor’s brain, encouraging brain plasticity repair. Stronger muscles and bones provide the strength and balance the neuro client needs to be active.
Physical therapy programs should be designed to help with mobility and relearning movement patterns, balance and how to stand and walk again. Neuro clients may need to go slowly, as they experience better functioning good days, and less functional bad days.
Walking ability has important health implications, providing protective effects against secondary complications common to neurological disorders. Physically disabling neurological conditions can result in secondary musculoskeletal complications that limit clients’ activities even further.
These secondary complications can develop at any stage after the onset of a neurological illness, including musculoskeletal issues, spasticity, increased pain, neuropathic joint issues, rheumatoid arthritis, systemic challenges, risk of falling, bone disease and fracture.
If left untreated, neurological disorders can result in many serious consequences. The short-term and long-term effects of neurological instability can vary greatly, depending upon the disorder and the severity of the condition. Long-term complications associated with nervous system disorders include chronic, disabling pain, increased immobilization, and depression.
Even if someone has been primarily wheelchair or bed-bound for years (with little intervention), they can achieve significant results and greater quality of life with patience, the proper program, and with proper equipment.
Many of our GHS clients see consistent standing and walking progress in the months, years, or even life span chronic neuro disorders. The brain has significant potential to do, adapt, and change, even years after illness.
Why is Walking Affected by Nervous System Disorders?
Strokes, demyelinating diseases of the nervous system (for example, multiple sclerosis), inflammation, or tumors can cause dizziness and balance problems.
The ability to maintain balance is determined by many factors, including physical strength and coordination, senses, and cognitive ability. Adjusting posture or taking a step to maintain balance before, during, and after movement is a complex process that is often affected after neuro illness.
Physical therapy should work on body discoordination issues to improve the patient’s standing, walking and balance, with an exercise program tailored to meet their specific needs.
A patient’s balance may be shaky if the cerebellum is injured. Along with weakness and loss of balance, many neuro patients experience sensory deficits.
Injury to the motor portion of the brain can also diminish muscle tone and control, another obstacle to walking. Muscles can lose the ability to contract altogether or, on the contrary, become overly contracted and too rigid to allow a simple walking motion.
How Does a Neuro Disorder Client Learn to Walk Again?
Before walking begins, a practitioner may guide the patient through pre-walking exercises to ready other pertinent muscles. If a patient’s trunk muscles were affected, causing him or her to lean to one side or to the front, therapy may start with core strengthening exercises in a sitting position.
The next step might be to work on standing until the patient feels anchored and secure. Learning to walk again involves scores of muscles and many isolated movements. Caregiver/practitioner and patient should approach the complex act of learning to stand and walk again in a safe, supported manner.
Physical activity remains a cornerstone in risk-reduction therapies for the treatment of neuro disorders. Regardless of how a neuro disorder client learns to walk again, one thing is certain: the client needs to get safely standing, balancing, and moving.
The months or years of recovery and attention to exercise may seem overwhelming, but neuro clients, caregivers, and practitioners need to keep in mind that the potential for progress and a healthier life is always there.
More Physical Activity Improves Brain Functioning
Early Intervention is Key
Literature shows that the best time for starting independent gait recovery occurs as soon as it is safe to do so, hopefully within the first few weeks or months after illness or injury.
There is growing evidence showing the provision of early ambulation support to critically ill and injured patients result in more favorable recovery outcomes as compared to less aggressive approaches.
A recent study at Cleveland Clinic found that patients participating in early mobility routines after neurological injury recovered quicker and went home earlier than those receiving standard care.
Evidence based practice confirms that ambulation spanning the acute through long-term neurological disorder recovery phases using an over-ground, all-in-one standing frame and walking frame support system, such as the Gait Harness System, should be encouraged. Functional recovery progress may then be made immediately, and in the months and years to come.
Impairments resulting from nervous system disorders, such as loss of sensation, muscle wasting and weakness, chronic pain, sleep loss, cognitive impairment, seizures, verbal and visual impairment, contracture, spasticity, tremors, poor coordination and balance can lead to a reduced tolerance to activity and further a sedentary lifestyle.
Immobility-related complications are very common in years following neurological disorders. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent.
To reduce risk of falls, individuals are encouraged to exercise regularly, focus on leg strength, weight bearing exercises, and improving balance.
Bone mineral is lost during immobilization. Sitting for more than 8 hours a day has been shown to negatively impact health and mortality. Standing and walking again are the recommended healthier alternatives.
The term “neuroplasticity” or “brain plasticity” describes the brain’s ability to reorganize by forming new neural connections necessary for recovery. both physically and functionally, throughout life, due to environment. Engaging in an active standing and walking process sends messages back to the brain, until the movement is relearned.
Neuroplasticity has profound impact on recovery from brain related neuro disorders because it means that with repeated training/instruction, even the damaged or compromised brain is plastic and can recover.
We are starting to realize there is more potential for recovery of the brain, and that recovery is not limited to the early months post neuro disorder. One of the biggest shifts in our understanding of brain plasticity is that it is a lifelong phenomenon.
More physical activity has been shown to improve brain functioning and improve executive function, which plays a role in reasoning and problem solving. Using MRI scans, researchers found that higher levels of physical activity also led to increased levels of brain activity while doing multiple tasks. Research is also showing that exercising regularly stalls brain shrinkage.
The right exercise, for the right duration, at the right time, can promote neurotrophic growth factors. Exercise plans should be done not only with a specific rehabilitation intent, but also with a whole-body focus. Cognitive, emotional, psychological, and physiological processes are intertwined. Improvement in one area tends to bolster improvement opportunities in other areas.
Over-ground Therapy is More Effective Than Robotic BWSTT
Body weight support treadmill training (BWSTT), which relies on total guidance of robotics, leaves little room for active effort on the part of the client, a key aspect in motor learning and functional gains.
Research shows that for most participants, BWSTT is not sufficient to induce long-term improvements in balance and balance confidence. Additionally, a recent study confirmed that “Body weight–supported treadmill training is no better than over-ground training for individuals with chronic stroke.”
Comparing over-ground training to the robotic treadmill training suggests that it is not the length of time spent in training, but rather how an individual engages in the activity that produces the results. Or, that a greater number of step repetitions produces greater functional change in walking ability, but only when transferring the skill to a natural walking environment.
In stroke survivors living in the community with marked limitations in walking, treadmill training with BWSTT 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.
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.
Compared to BWSTT, a recent study showed that step-length symmetry ratio improved only with the over-ground therapy gait group. Reduced step length symmetry ratio has been found to increase fall risk. Improving step length symmetry through over-ground gait training has the potential to decrease fall risk.
Improving gait symmetry through over-ground practice, in the “real world,” contributes to a goal of more “normal” walking patterns.
The Second Step GHS encourages client-centered, supported, faster walking and more functional, natural movement. The System provides a novel, optimal gait training strategy for neurological clients, enabling goal-directed recovery and maintenance of walking ability.
Ready, Set, Walk!
The best way to improve coordination, balance, and learning to stand and walk again, is by practicing regularly. Too often patients only do their exercises in physical therapy.
Some days putting in the hard work for nervous system functional recovery can be difficult. Recovery takes time. However, there should be increased health maintenance and gradual ambulation improvements over the months.
Maintaining those exercises long term, for as many years as is needed, is often needed to maintain the gains made in therapy.
With proper practitioner/caregiver support and safe therapy equipment, neuro disorder clients can reduce high risks for falls, fractures, learned non-use behavior, and further declines in mobility.
Beginning to walk again, even long after neuro disorder, has been associated with functional gains. Taking a brisk half-hour walk outdoors three times a week can significantly boost stroke survivors’ physical fitness and improve their ability to get around — all within just a few months, new research from Stroke, a journal of the American Heart Association, shows.
The future for people living with and recovering from neuro disorders is more optimistic than it has ever been.
Repetition, Intensity, Practice: it Takes Commitment
New findings by researchers at University of California, San Diego School of Medicine report that not only is rehabilitation vital, but that a longer, even more intense period of rehabilitation may produce even greater benefit.
Researchers found that intensive therapy, for an extended period, showed significant restructuring of the brain around the damage site. The result was a dramatic 50% recovery of function.
How do neuro clients move beyond the obstacles of learning to walk again? Through caregiver and practitioner support, sheer determination, and a mindset of never giving up, no matter how long it takes: repetition, intensity, and practice.
Coordination, balance, and walking exercises need to be done about five times per week, sometimes more than one time per day to get the full effect. As always — practice, practice, practice, and the client should hopefully see progress learning to walk again.
Studies show a daily commitment to standing and walking therapy practice (or ideally multiple therapy sessions daily) yields the best outcomes.
GHS Allows for Therapy in the Clinic, and in the Home
However, often the amount of walking completed by individuals with neuro disorders attending rehabilitation is far below that required for independent community ambulation.
If you’ve worked with a rehab therapist, you’ve likely heard them emphasize the value of home carryover exercises in between sessions, and the importance of quality, consistent, focused practice at home once therapy is finished.
Treatment intensity and duration in hospital and skilled-nursing facilities cannot be maximized to the point required for optimal recovery, nor do these environments provide appropriate demand or context to allow efficient and effective learning or generalization of learning. Researchers have not been able to identify a ceiling for treatment intensity. More therapy is better than less.
Advances in therapy equipment, such as provided by the Gait Harness System for Home Users, allows clients to actively participate in therapy in their homes at their convenience, empowering them to take control of standing and walking again therapy, instead of being passive consumers.
Evidence supports the impact of home-based supported standing and walking programs on range of motion and exercise activity. 60 min of standing and walking practice daily is suggested for mental function and bone mineral density. The Second Step GHS provides a unique, safe combination of standing frame and walking frame benefits for neuro clients who need the extra support while learning to walk again.
Many people think after a certain number of years, they’re not going to make progress. Research shows that is simply not true. With hard work, people with neuro disorders can continue to improve their balance for many years after illness.
Walking again enhances life quality. Every step forward is progress.
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