脊髓损伤后的步行训练

概述

经历过脊髓损伤或功能障碍的患者可从行动训练中获益。行动训练是一种以活动为基础的疗法，通过有挑战性的练习和下肢负重改善并恢复行走运动。

如果您正在经历以下情况，可能会受益于恢复运动能力的治疗：

• 运动和感觉受损
• 行走困难
• 难以参与日常活动

行动训练的设备和技术可能会根据您接受治疗的位置而有所差异。可选方案包括：

• 机器人辅助减重支撑步行系统（Lokomat）
• 减重支撑跑步机训练
• 不用跑步机进行的减重平地步态训练
• 平地步态训练，如行走或站立
• 功能性电刺激

目的

Locomotor training for a spinal cord injury can help people recover their ability to walk if they're experiencing:

• Trouble with movement and feeling.
• Trouble completing daily living activities.

A spinal cord injury causes a loss of feeling that makes it hard to stand and walk. But many people with spinal cord injury can regain some function. Some may potentially be able to walk again.

Locomotor training focuses on recovery of the areas of the nervous system that are damaged. The goal is to help someone with a spinal cord injury recover posture and the ability to walk. The training helps preserve muscle and restore movement and feeling. Locomotor training also can help damaged nerve cells regenerate. This can help people regain balance and the ability to move.

Locomotor training is different from traditional spinal cord injury rehabilitation. Traditional rehabilitation focuses on using muscles above the injury to learn to move parts of the body that are weak or paralyzed. Traditional therapy doesn't usually include walking.

Studies have found that locomotor training has helped people with spinal cord injury improve function and walking ability. The training also helps improve health and cardiovascular fitness.

风险

When locomotor training for a spinal cord injury is done with specialists trained in the therapy, there are few risks.

如何进行准备

Before beginning locomotor training for a spinal cord injury, get a medical evaluation. It's important to check that your blood pressure remains stable when you are upright before you begin the training.

可能出现的情况

Locomotor training for a spinal cord injury may involve a variety of devices and techniques. These may vary depending on where you receive your therapy. Options include:

• A robot-assisted body-weight-support treadmill system.
• Body-weight-support treadmill training.
• Body-weight-support overground training, which is done off the treadmill.
• Overground activities, such as walking or standing.
• Functional electrical stimulation.

A physical therapist or exercise specialist designs a program based on your level of spinal cord injury. The level of spinal cord injury is the lowest part of the spinal cord not damaged. The program focuses on your goals and preferences for gaining strength and skills. It also focuses on which parts of the spinal cord need to be stimulated.

During locomotor training

Locomotor training involves repeating movements to activate the nervous system. Your specific training depends on your goals and your level of spinal cord injury. Some people getting locomotor training need more help from a standing frame or from a therapist than do others.

During locomotor training, you may use a body-weight support system with a treadmill. Therapists help you balance and move your trunk and legs to stand and walk. If you're using a robot-assisted body-weight treadmill system, an exoskeleton attaches to your legs to guide you while stepping. You also might have overground training off of a treadmill without a harness.

If your locomotor training includes functional electrical stimulation, electrodes are placed on the muscles being trained. An electrical current passes through the electrode to stimulate a nerve or muscle. This is done while you're being assisted during walking. This can help activate the muscles you're working, making them stronger and improving function and movement.

Locomotor training sessions may last two or more hours and may be done 3 to 5 times a week.

结果

Some studies have found that locomotor training for a spinal cord injury can lead to improvements in function. People with some feeling and function after a spinal cord injury have increased their walking speed and distance with robot-assisted locomotor training. They've also improved their coordination. The training also has helped people with complete and incomplete spinal cord injury improve their cardiorespiratory health and reverse muscle loss, known as atrophy. Blood pressure control also can improve.

But the study results are mixed. Some people with spinal cord injury don't experience an improvement after activity-based therapy such as locomotor training. Some research suggests that moderate- or high-intensity training leads to better improvements. More study of locomotor training is needed to understand the benefits of the therapy.