http://cbshealthwatch.medscape.com/cx/viewarticle/215531

Nov 2001
Gina Shaw, Medical Writer

A few months ago, Sherri Drakeford would never have dreamed she could walk on crutches. The 45-year-old mother of two had been hit with a double health whammy: After years of battling multiple sclerosis (MS), she was diagnosed with breast cancer. Drakeford had three surgeries and spent 12 weeks in the hospital, followed by 7 weeks of chemotherapy. What progress she had made in strengthening her body and fighting for mobility was erased by postsurgical weakness and months spent in bed.

Then Drakeford's neurologist at the University of Texas-Southwestern Hospital in Dallas heard about an exciting new machine that had been brought in by Patricia Winchester, PhD, chair of the hospital's physical therapy department. The innovative treatment uses a combination of a treadmill and a suspension harness to help people with spinal cord injuries and other disabilities regain some of their ability to walk.

In September 1999, Drakeford began a rigorous training program on the treadmill. In a typical training session, Drakeford is strapped into the harness like a mountain climber. Then, Dr. Winchester wheels her up a ramp onto the treadmill. She's hooked up to a suspension system at the shoulders, and hydraulic lifts hold her upright. Then she takes one step, then another, and another. Two to three times a week since September, she has traveled to the medical center. She is improving her stamina, balance, and ability to support her own weight, week by week.

"For the first time in 4 years, I can walk on crutches," Drakeford reports ecstatically. "I showed my oncologist last week and he was stunned: I can't wait to show my neurologist. I can't walk a long way and I have to have someone spotting me, but never in my wildest dreams would I have thought I could walk on crutches at all."

Learning To Walk Again
 
Essentially, the system retrains the body to walk. For patients with neurological deficits caused by spinal cord injury or MS (like Drakeford), poor muscle strength, decreased muscle tone, and poor balance make walking difficult. Treadmill workouts help to retrain the locomotive center in the spinal cord, which Dr. Winchester says is thought to control the step patterns of walking. The suspension harness allows patients to bear as much or as little weight as they can manage, gradually moving up to standing more and more under their own power.

"The number-one outcome is improving a person's function. Once they start walking, they will maintain the level they have achieved through therapy," says Dr. Winchester.

So far, Dr. Winchester has worked with a total of 13 patients using the treadmill-suspension system: six MS patients, six spinal cord injury patients, and one woman with a traumatic brain injury. She happily reports that every one of these patients is making progress.

"One patient with spinal cord injury had been doing physical therapy for a year and still was not ambulatory," says Dr. Winchester. "He's a T-10 paraplegic. After 2 weeks on the harness, he's already started walking with crutches over ground."

The woman with traumatic brain injury has also experienced remarkable results using the treadmill and harness. Three years after her injury, she continued to experience such severe tremors that she couldn't even roll over in bed by herself. After 6 months of using the treadmill, says Dr. Winchester, "She's now independent in bed mobility, transferring independently from her bed to the wheelchair to the toilet, and she's now walking with minimal assistance with a rolling walker." On the treadmill, Dr. Winchester reports, the tremors aren't even visible any more.

Dr. Winchester's case reports of success jibe with peer-reviewed reports from the University of Bonn, where weight-suspended ambulation was first used in this way. It has been used for some time to rehabilitate stroke patients. But Dr. Anton Wernig, a German researcher, was the first person to use the treadmill training for patients with spinal cord injuries. Previous studies showed that function in paralyzed animals improved with treadmill therapy, and their condition deteriorated once they stopped.

Dr. Wernig, who dubbed the treadmill system "Laufband," has published reports of the system's success in several international neurology journals. "Many patients with chronic paralysis, still wheelchair-bound and not capable of walking without help from others, became independent and learned to walk for some distance without help," he writes in the August 1999 issue of the Journal of Neurotrauma. In cases of both acute and chronic paralysis, the German studies find that patients who participate in treadmill therapy fare better in achieving improved mobility--sometimes after years in a wheelchair--than do patients who pursue standard rehabilitation therapies.

"Our hope is that if patients can learn to walk over ground independently, they won't have to rely on other people or wheelchairs for assistance," says Dr. Winchester. "My goal is not for them to walk on the treadmill the rest of their life, but for them to get improved enough to walk in their home and in the community setting."

Drakeford, for one, is a believer. A few weeks ago, she returned to the community gym where she can once again exercise independently. "It's given me the confidence that I can get up and walk again, at least in the walker and maybe on crutches," she says. "After 4 years, that realization just about blew me away."

The treadmill system is now being tested on patients with varying degrees of paralysis at half a dozen centers in North America:

• UT Southwestern.
• UCLA Medical Center.
• Cleveland Clinic.
• Mississippi Methodist Rehabilitation Center.
• Houston VA Medical Center.
• Montreal Rehabilitation Institute.