Locomotor Training

For individuals with motor incomplete spinal cord injury, Shepherd Center offers a program of walking interventions directed by a specialized group of therapists. This program is called Shepherd Step and aims to help participants regain the highest possible functional level of walking.

Shepherd Center is also a is one of seven rehabilitation centers that have partnered partner with the Christopher and Dana Reeve Foundation and the Centers for Disease Control and Prevention (CDC) as part of the NeuroRecovery Network (NRN), which provides and develops therapies to promote functional recovery and improve the health and quality of life of people with paralysis. Though Shepherd Center is not currently enrolling participants in NRN, staff members continue to contribute to research that translates the latest scientific advances into effective, activity-based rehabilitation treatments.

Shepherd Step Program

Shepherd Step is an intensive walking program to assist participants with motor-incomplete spinal cord injury in regaining the highest possible functional level of walking. Shepherd Step is staffed with a group of dedicated professionals who have received specialized training to deliver walking interventions. Based on the judgment of the participant’s physician and physical therapist, these interventions may include use of the following devices:

  • Body-Weight-Supported Locomotor Training (BWST) with either manual or robotic assistance
  • Neuroprostheses
  • Parastep
  • Orthotics or Braces
  • Training in Over-ground Walking

What is Body-Weight-Supported Locomotor Training?

Body-weight-supported locomotor training uses specialized body-weight-supported treadmill systems. In locomotor training sessions, the participant is suspended in a harness over a treadmill while either a specially trained team or the robotic system moves the participant’s legs to simulate walking. As the individual regains function, they progress from the treadmill to walking over ground. Locomotor training stems from recent advances in scientific understanding about neural plasticity (the ability of neurons in the nervous system to develop new connections and “learn” new functions) and the role that the spinal cord plays in controlling stepping and standing. Locomotor training may work to “awaken” dormant neural pathways by repetitively stimulating the muscles and nerves in the lower body.

Research shows that locomotor training,  through the use of body-weight-supported treadmill training, improves over-ground walking in individuals who have movement in their legs. To date, research has not shown this therapy to improve walking in patients who do not yet have movement in their legs.

What are Neuroprostheses?

Neuroprostheses are devices that deliver functional electrical stimulation (FES) to help move the legs, which would not be functional without such a device. Neuroprostheses use electrodes placed over the  legs and consist of a control box and a cable connected to a walking device. The box houses the command switch(es) for step functionality. The most widely used FES devices also have been designed to address foot drop to improve over-ground walking. Research shows promising results in all outcome measures of walking, including functional mobility, speed, spatiotemporal parameters and the physiological cost of walking.

What is Training in Over-Ground Walking?

For individuals with strong leg movement who can support their body weight in an upright position, over- ground walking may be an option with or without specialized equipment and custom orthotics.

Potential Outcomes of Locomotor Training Include:

  • Improved quality of walking
  • Increased walking speed
  • Increased walking endurance
  • Decreased use of devices

Because of these well-documented results, over-ground walking has become a standard of practice at Shepherd Center to integrate locomotor training across the continuum of care for individuals with leg movement The program serves inpatients and outpatients, including those in Shepherd Center’s Day Program and Beyond Therapy®.

Specialized Equipment Used For Locomotor Training

  • Bioness/Walk Aide Neuroprosthesis - A device used to stimulate the lower leg during locomotor training
  • Lokomat® - Robotics-assisted treadmill training with body-weight support
  • Orthotics or Braces - Evaluation and training completed in conjunction with a consulting orthotist
  • Pacer and Arjo - Professional equipment resembling a “super” walker used to provide over- ground training
  • Parastep - A neuroprosthetic device used to stimulate the entire leg during locomotor training
  • Therastride - Manual treadmill with body-weight support
  • Zero G - A static or dynamic system with body- weight support used with over-ground training

Criteria for Admission to Shepherd Step

Individuals selected for Shepherd Step must meet the following guidelines:

  • Must safely tolerate upright position and weight- bearing
  • Have defined and realistic functional ambulation goals
  • Must have prescription from physician

For More Information on Shepherd Step

To get additional information, contact Jana Candia, Shepherd Center Post-Acute Case Manager, at 404-350-3102 or jana.candia@shepherd.org

Download the Shepherd Step Fact Sheet as a PDF file by clicking here.