Bruce H. Dobkin, M.D.
Professor of Neurology
UCLA School of Medicine
Safe home and community ambulation becomes one of the most important rehabilitative goals of patients with neurologic diseases such as stroke, spinal cord injury and multiple sclerosis. The efficacy of one conventional style of physical therapy program over another to facilitate these functions remains to be shown. While task-specific therapies and principles of motor learning have been offered as a potentially better approach to therapy, very few randomized clinical trials have defined an intervention, and then entered enough cases to learn whether or not one approach really works better than another. Treadmill training with partial body weight support, usually with manual assistance of leg movements by therapists as needed, draws upon much experimental work on cortical sensorimotor representational plasticity, central pattern generation for locomotion, spinal "primitives," spinal cord motor learning and a rich set of experimental studies in spinal transected mammals. It entails the use of specific locomotor-related sensory inputs during the practice of a functionally meaningful, task-oriented therapy. The physical and cognitive demands of manual assistance provided by therapists can be considerable as they try to optimize timing, kinematics and limb loading and unloading during the swing and stance phases of the stepping cycle. The technique, however, may improve the level of independence in walking over ground, walking speed and endurance, head and trunk control, transfers, conditioning, lower-extremity muscle mass and health-related quality of life. As this intervention is being defined and tested across a variety of diseases that impair walking, exoskeletal robotic devices are also being developed to lessen the demands on therapists and perhaps improve the training technique. Manual and robotic approaches may be combined with locomotor neural modeling and forms of feedback during walking, functional electrical stimulation during portions of the step cycle and pharmacologic agents and biologic rewiring interventions to enhance motor recovery.
Bruce H. Dobkin, MD
Professor, Department of Neurology
University of California Los Angeles
Reed Neurologic Research Center
Neurologic Rehabilitation and Research Program
710 Westwood Plaza
Los Angeles, CA 90095-1769