Techniques

Locomotor training is an emerging rehabilitation intervention for recovery of function after neurologic injury or disease and the physiological basis and scientific evidence supporting its use is discussed in this book. The book also reviews physical rehabilitation for posture, standing, and walking from a historical perspective that provides a context for the emergence of locomotor training as an activity-based therapy after spinal cord injury (SCI) and stroke by implementing evidence-based practice providing new strategies to augment already successful therapeutic approaches. As an activity-based therapy, locomotor training provides activation of the neuromuscular system below the level of lesion with the goal of retraining the nervous system to recover specific motor tasks related to mobility, posture, standing, and walking. The book presents the four guiding principles that serve as the basis for clinical decisions throughout the three components of locomotor training. Successfully providing the locomotor training intervention is dependent on knowledge, skill, proper equipment and attire, and clinical decisions for progression. Community integration prepares the client for functioning at home and in the community. The primary goal of both overground assessment and community integration is to translate the capacity of the nervous system developed during step training to walking at home and in the community. The locomotor training intervention is implemented by identifying specific goals based on the current phase of recovery. Properly and continuously challenging clients to achieve higher levels of performance is critical to recovery. Even though the accomplished neural plasticity may not have yet resulted in reaching functional goals such as transferring, standing, or improvements in walking, the assessments in the phasing will show more incremental changes in neural recovery. The sequence of implementing these specific goals is based both on the scientific evidence and the experience of many physical therapists who have provided the intervention in research and clinical environments over the past decade.

This book discusses a general problem in biology: the lack of an adequate language for formulating biologically specific problems. This book describes recent progress in the control and coordination of human movement. It begins with a brief history of movement studies and reviews the current central controversies in the area of control of movements with an emphasis on the equilibrium-point hypothesis. An operational definition of synergy is introduced and a method of analysis of synergies is described based on the uncontrolled manifold hypothesis. This method is further used to characterize synergies in a variety of tasks including such common motor tasks as standing, pointing, reaching, standing-up, and manipulation of hand-held objects. Applications of this method to movements by persons with neurological disorders, persons with atypical development, and healthy elderly persons are illustrated, as well as changes in motor synergies with practice. Possible neurophysiological mechanisms of synergies are also discussed, focusing on such conspicuous structures as the spinal cord, the cerebellum, the basal ganglia, and the cortex of the large hemispheres. A variety of models are discussed based on different computational and neurophysiological principles. Possible applications of the introduced definition of synergies to other areas such as perception and language are discussed.