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
- 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 or ceiling-mounted systems that run on a track. 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.
- Improved quality of walking
- Increased walking speed
- Increased walking endurance
- Decreased use of assistive devices
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 exoskeleton training, must have completed all other functional goals and meet all requirements for a personal use device
To get additional information, contact Shepherd Center Post-Acute Admissions Representative at 404-350-7502.