Central Nervous System May Be Retrained, Report Led by Physical Therapist Shows
ALEXANDRIA, VA, June 4, 2008 — A new report shows that a
non-ambulatory (unable to walk or stand) child with a cervical spinal
cord injury was able to restore basic walking function after intensive
locomotor training. The case study, published in Physical Therapy (May 2008),
the scientific journal of the American Physical Therapy Association
(APTA), evaluated the effects of locomotor training in a 4 1/2
year-old-boy, who had no ability to walk following a gunshot wound
sixteen months earlier.
"Every standard clinical evaluation conducted on this child indicated
that he would not regain the ability to stand or walk," said Dr Andrea L
Behrman, PT, PhD, Associate Professor in the Department of Physical
Therapy, University of Florida and APTA spokesperson. Dr.Behrman, the
lead author of the report, observes. "This case study is significant in
that it shows that a severely injured spinal cord may be retrained."
But, Dr Behrman cautions that, while this is a significant step in the
right direction, not all children with severe spinal cord injuries will
benefit from this type of treatment or have the same results.
Locomotor training refers to a process developed out of a partnership
with scientists in which the patient is put in an environment to
practice "walking" movements over and over again. Over the course of 76
sessions, the child was placed in an overhead body weight support system
and suspended over a treadmill while three trainers helped simulate
walking by moving his legs in a stepping pattern. "With this system, the
patient is partially supported, allowing the trainers to faciliate
stepping and standing movements," Dr. Behrman explained. She cautioned
that many rehabilitation facilities lack the equipment and staff skills
to provide this kind of intense therapy, but that her case study clearly
shows what can happen when available. "We are optimistic that this case
study will give hope to individuals with spinal cord injuries as well as
to their families," she said.
Dr Behrman noted that one month into locomotor training, voluntary
stepping began and the child eventually progressed from having no
ability to using his legs to moving with a rolling walker. The child is
now fully ambulatory with a walker and attends kindergarten using a
walker full-time. Although he has balance difficulties, requiring the
use of a walker, Dr. Behrman said that, in time, a walker may not be
necessary.
Dr Dena R Howland, OT, PhD, Associate Professor in the Department of
Neurological Science at the University of Florida's College of Medicine,
and a co-principal investigator for this case study, notes that the
complete support of the patient's family was a huge part of his therapy
success. "The fact that the physical therapists were able to get the
child to the level of functional ability that they did most likely would
not have been achieved without the perseverance and commitment of this
boy's family," she said.
Dr Behrman added that research findings from reports such as this
serve to change and guide clinical practice for the physical therapy
profession. "Identifying patients who have the potential to benefit from
locomotor training or other therapies is an important step in clinical
decision making," she said.
Physical therapists are health care professionals who diagnose and
manage individuals of all ages, from newborns to elders, who have
medical problems or other health-related conditions that limit their
abilities to move and perform functional activities in their daily
lives. Physical therapists examine each individual and develop a plan of
care using treatment techniques to promote the ability to move, reduce
pain, restore function, and prevent disability. Physical therapists also
work with individuals to prevent the loss of mobility by developing
fitness- and wellness-oriented programs for healthier and more active
lifestyles.
The American Physical Therapy Association (www.apta.org) is a
national organization representing physical therapists, physical
therapist assistants, and students nationwide. Its goal is to foster
advancements in physical therapist education, practice, and research.
Consumers can visit www.findapt.us to find a physical therapist in their
area, as well as www.moveforwardpt.com for physical therapy news and
information.