Significant scientific advances have been made in our understanding of how the brain and spinal cord communicate and their capacity to rewire after injury. As a result, new rehabilitation strategies have emerged, among them - locomotive gait training. The sensory input of a moving treadmill coupled with moving ones legs in a walking motion have been proved to trigger reflexes the in the spinal cord that are capable of reproducing steps. Many people with an SCI, regardless of the time elapsed since their injury, have improved their walking after receiving locomotive gait training.
We used to believe that the brain gave an executive command to the spinal cord which enabled us to walk. We thought the spinal cord was simply a courier of the command to the muscles, but it turns out this isn’t entirely correct. The spinal cord is smart and can store sensory information, recognize this information and respond without brain activity.
On our WOODWAY Bari-Mill treadmill, clients are safely harnessed into an overhead track system. Trainers will unload a portion of the clients’ bodyweight – depending on their abilities. Body weight support starts between 35% & 50%, if greater than 60% the client will be walking on their toes, decreasing hip knee flexion during the swing phase and activity in the postural muscles. The speed of the treadmill depends on a client’s tone, spasticity, degree of passive/active participation. We start slow and work into faster speeds (paying careful attention to the integrity of their gait pattern) while the client’s legs are manually moved one at a time by our trainers in a rhythmic motion that simulates walking. If the client has voluntary control of his or her legs, they actively assist as much as possible. Benefits include maintaining muscle mass, reducing spasticity, improving strength, and enhancing cardiovascular function.
The ReWalk is an exoskeleton suit with motorized legs powering knee and hip movement. Its patented technology controls movement using subtle changes in center of gravity to mimic natural gait and provide a functional walking speed. The system senses a forward tilt of the upper body to trigger the first step. Repeated body shifts produce a sequence of steps in a natural and efficient walking gait. With specialized training and practice, ReWalk users can also sit, stand, turn, ascend and descend stairs.
The ReWalk system provides a form of exercise that is beneficial for wheelchairs users with limited exercise options because it mimics a natural walking motion and requires users to control their body movements. The system is adjustable for different users, and can accommodate a range of heights ( approx. 5’3” to 6’3” inches) or weights (up to 220 pounds).
The ICARE (Intelligently Controlled Assistive Rehabilitation Elliptical) is an elliptical with pneumatic unweighting and adaptive motor assistance. It closely mimics the kinetic and electromyographic patterns of walking. The ICARE aids in restoring motor function by placing a demand on one's nervous system through thousands of task specific repetitions. Studies have shown ICARE training can help individuals regain or retain the flexibility and strength required for walking. Our specialists can control body weight, repetitions, and assistance/resistance particular to each client.
The LiteGait is another weight-suspension load bearing training device. The support of the harness positions clients in correct standing posture and allows for a “fall free” training environment, the handlebars provide added stability, and the dual column lift allows trainers to load/unload clients’ bodyweight. This is also a key piece of equipment for reintroducing clients with low bone mineral density into partial-load bearing standing exercises. At REACT you’ll see clients working over ground gait training, weight-assisted squats and sit to stands, weight shifting and postural balance exercises, and supported cardio spin bike routines.
The Solo-Step is a high performance 30-foot, ceiling-mounted track and trolley system. The Solo-Step allows clients to practice above ground gait training in a harness – eliminating the fear of falling. By providing clients a “fall free” environment, they can push themselves harder and try more complex modalities. The patented harness is worn like a backpack and fastens to the client from the back, providing the freedom to move in frontal, transverse and sagittal planes without interference. You’ll see our clients crawling, kneeling, walking sideways, backwards and frontwards…with endless possibilities! The harness also allows our specialists to unweight a client, if needed, to reintroduce clients with low bone mineral density into partial-load bearing exercises.
Vibe Plate's products provide vertical micro hits of gravity to enhance the gravitational effects of load bearing activities. Vibration therapy is beneficial to our clients because it lowers the excitation threshold of reflexes, which in turn allows them to connect to the contraction of muscles with more ease. The stimulation also subconsciously stimulates axons, which carry messages to our muscles telling them to contract – thus activating muscles that would otherwise not fire. Other benefits include decreased spasticity, increased bone density and slowed atrophy of muscles – all of which reduce the risk of fracture in clients with osteopenia and osteoporosis.
The lower threshold for muscle excitation allows trainers to work with clients on strengthening exercises that increase voluntary movement and endurance. For example, clients may have voluntary movement in their upper body, but its weak and limited so they are unable to push themselves up, reducing independency. The vibrations of the Vibe Plate allow these clients to do unassisted push-ups, giving them motivating results. Other clients begin making improvements in their quad strength but when they actually stand the muscle is too weak to support their full body weight. Add the assistance of vibration therapy and these clients can begin to stand independently and for longer periods of time.
The Tunnel Walk is a groundbreaking functional rehab platform that combines the benefits of vibration therapy with a body-weight suspension cage and walkway. REACT is the only facility in the world to have this equipment - as our Specialists worked to help create the first ever prototype. The Tunnel Walk provides freedom to move in 3 planes of motion without fear of falling. Our clients are enjoying crawling, kneeling and walking while having the therapeutic, training and conditioning benefits of vibration. Some clients are noticing an improvement in their ability to connect with weaker muscles, significantly improving their gait training experience.
The Galileo differs from Vibe Plate and Power Plate in that it is the only side-alternating vibration platform in the world. Galileo is a neuromuscular training and communicating tool working within the speeds of the nervous system to optimize motor relearning under the principle of high repetition and decreases the complications of long-term immobility. It’s seesaw motion pattern simulates the natural human gait causing a tilting movement of the pelvis, just like when walking but at a more rapid pace. To compensate the body responds with rhythmic muscle contractions, alternating from the left and right side of the body. Unlike other vibration devices, Galileo training recruits the afferent (sensory) and efferent (muscle) systems putting small and large antagonistic muscle groups through thousands of reflexive (involuntary) muscle contractions - all in a matter of minutes.
From a frequency of about 12 Hz and up, muscle contractions are not a conscious process but rather a reflex. This reflex activates and enhances an unparalleled rapid change in the user’s neuromuscular function and neural communication. For frequencies under approx. 12 Hz the contraction time of the muscles is already too long and the reflex is not triggered. For frequencies over 30 Hz the mechanical stimulus is transmitted to the body so quickly that the physiological capability is no longer effective. After just a few minutes of Galileo training, the affected muscles or entire muscle chain receive hundreds of stimulating impulses.
The Keiser Power Rack has two pneumatic strength columns that provide air resistance training. Clients are harnessed or fitted into a vest and secured to the overhead pulley system, enhancing power and stability while achieving safe effective training results. Keiser’s pneumatic technology has the added benefit of zero shock loading to the connective tissue and joints – allowing clients to build muscle without compromising joint stability. Foot pedals located on each side allow trainers to easily adjust the resistance and load providing a unique opportunity for clients to relearn and test their body’s limits.
One of the many benefits of using pneumatic air is the consistent quantitative feedback it provides our clients and trainers. Clients can practice assisted sit-to-stands at a certain PSI (i.e. 90) and over the course of their training, as muscle function and power improve, the client can perform the same sit-to-stand at a lower PSI (i.e. 60) and have a measurable output to quantify that improvement.
The Functional Trainer incorporates two adjustable arms driven by pneumatic resistance. The versatility of this equipment makes it a favorite around REACT. On a given day you'll see clients standing in the parallel bars using the Funcitonal Trainer to do resistitve standing core routines, upper body strengthening exercises, assisted back extensions, etc. Beyond its resistance training abilities, our Specialists also use the pneumatic weight to provide hip or core stability while practicing hands-free standing and walking.
The repetitive nature of riding a spin bike is critical in restoring motor function. The more repetitive gait training a client gets, the better chances they have at reorganizing their nervous system. While riding the spin bike our clients are working continuous, coordinated hip flexion/extension and knee flexion/extension.
Trainers adapt their set-up on the spin bike in accordance with a client’s abilities. For those with minimal upper body strength, trainers begin introducing client to the spin bike in a recumbent position. As they progress we put them in an upright position supported by the LiteGait, followed by an elbow walker, and eventually to an unsupported independent upright position. When upright, clients grasp the handle bars, bend at their elbows and rock back and forth into their hips, creating momentum and movement in their legs.
FES is the application of small electrical pulses to specific muscles (usually the quads, hamstrings and glutes). Coordinated electrical pulses excite the peripheral nerves of a muscle and force it to contract. Sensors then provide constant feedback to the computer, controlling the sequence of muscle contractions, the pulse width and amplitude of the current and the resistance to pedaling. The repetitive gait pattern mimicked while riding the FES bike helps restore neurological and functional movement, while the forced contractions help increase muscle memory and mass. At REACT we have 2 FES bikes and encourage clients to also schedule weekly FES bike sessions to get the most out of their recovery.
We must note that because an FES bike carries electrical pulses to the body, there are clients that cannot use this piece of equipment. If you have a cardiac pacemaker, unhealed fracture, or are pregnant, you cannot use the FES bike. Other restrictions can include clients with severe spasticity, limited range of motion, severe osteoporosis, pressure sores or open wounds in areas to be stimulated, or implanted hardware less than 3 months old.
In addition to using FES on the bike, our specialists often use the portable SAGE simulator to add electric stimulation to other training modalities. In a functional capacity, the SAGE simulator can be set on a program that mimics specific movement patterns. For example, when a client is on the Total Gym working leg presses, a program can be set to ramp up the electrical impulse during the press phase and shut off during the resting phase. The pads would be placed on the quads, hamstrings and/or glutes depending on the focus of the particular exercise. By adding FES to other strength and gait training exercises our clients get an added benefit of deeper muscle contractions, enhancing functional recovery.
Our bodies deteriorate in a reduced gravity environment, resulting in loss of bone density and muscle mass. Thus the act of standing is so important for our clients’ health. Standing frames are typically paired with other equipment throughout the gym to provide clients a comprehensive standing, strengthening exercise regimen. Trainers have clients stand and move through sequences of dumbbell presses, cable resisted rows and flys, back extensions, resisted core, squats and sit-to-stands. We encourage clients to come in on their off days and utilize the standing frame if they don’t have access to one at home.
The Neurac (Neuromuscular Activation) Redcord system is a series of slings and bungees that traverse an overhead track system. This bodyweight suspension system focuses on the neuromuscular system and how it influences human movement and performance. Clients are supported by a series of ropes, slings and bungees as trainers assist them with carefully designed stabilization and strength routines for core, upper body, hip flexors and glutes. The “bungee assistance” allows trainers to unload portions of the client’s bodyweight with slings, providing support to the head, trunk and/or extremities during the exercises, ensuring proper form and biomechanics while avoiding pain and compensation. The Redcord system is a great way to get clients in a safe neutral spine position while strengthening the entire musculature of the body – challenging every level of injury day in and day out.
As mentioned in the section above on Standing Frames, when the human body is deprived of gravitational load bearing, there is loss of muscle mass and bone density, decreased circulation, coordination and CNS activity. Thus, our overall health is compromised. To reverse the effects of being wheelchair bound our clients need regular strengthening exercises with an emphasis on load bearing. The Total Gym is the perfect piece of equipment to start reintroducing load into a client’s skeletal system. For clients with osteoporosis this is the first place our trainers begin working to restore bone density. The closed chain platform and angled sled move in accordance with each client’s own body weight. Exercises include single and double leg presses, seated core routines and back extensions.
The Shuttle Recovery is a progression from the Total Gym. As clients gain muscle strength and function on the Total Gym, we can advance them to the Shuttle Recovery where elasticords provide anywhere from 12 to 300 pounds of progressive resistance. Slightly different from the Total Gym, this equipment introduces load bearing in the form of resistance rather than gravity. Specialists can zero out the effects of gravity while clients lay supine, working range of motion and progressive resistance squats.
The Combo Twist works rotational movements while standing. Being in a wheelchair limits a person to a single plain of movement – forward flexion. Thus, working rotational movements in the thoracic and lumbar spine is extremely beneficial in strengthening spinal erectors (back muscles) that aid in standing balance and posture.
The Hip/Glute machine functions just as it sounds and is one of our most popular pieces of equipment. The focus is on working assisted hip flexion and resisted hip extension. Clients need varying degrees of assistance and work to remove weight from hip flexion and increase weight into hip extension. An added benefit, this machine helps stretch out clients with shortened and tight hip flexors (a common side effect of living in a wheelchair).
The Smith Machine is a barbell system running along steel rails within a power rack. The barbell is limited to vertical movements, benefiting clients who are trying to build strength through foundation movements such as squats, bench press and shoulder exercises. Our trainers utilize the power rack structure to creatively tie resistance bands overhead and laterally for standing/core strengthening sequences. A favorite among quadriplegic clients is the assistive and resistive bench press set up – allowing them to rep out multiple presses and increase upper body strength.
The Cable Crossover is a double towered weight stack machine with 10 pound plates on each side, adjustable up to 100 pounds, with various handle and leg strap accessories. This dynamic piece of equipment allows trainers to work with clients at all stages of their recovery, working weight assisted or resisted exercises for upper body, lower body and core strengthening. While lying on a table, more advanced clients are attached to the cable via a calf strap and work through controlled nervous system activation techniques with weight resistance. This allows opposing muscles to work simultaneously through concentric and eccentric contractions, strengthening quads, hamstrings, glutes, or hip flexors, depending on the focus. Clients working toward upper body strength and conditioning goals are positioned on the floor with back support and then gloved to a handle or bar attached to the weighted cable. By increasing or decreasing the amount of weight, trainers can put clients through rigorous upper body exercises. The possibilities of this machine are endless and we encourage our trainers to push their creativity. You’ll see clients working split leg standing core, kneeling core, standing frame resistance pulls, resisted hip flexion in hands and knees, standing balance and sit-to-stands with the floating cook bar…come on by and see for yourself!