By Karen Warmkessel
More than 12,000 people in the United States are diagnosed with new spinal cord injuries each year. They experience varying degrees of paralysis, depending on their injury. For physicians, the challenge is to determine how to best care for and rehabilitate these patients.
At the Rehabilitation Research Center at Kernan Hospital, researchers have investigated whether using robotic treadmill training can improve the physical fitness of spinal cord-injury patients and increase their mobility. Key to their studies is a robot-assisted training device called Lokomat, which supports patients in a parachute-like harness while it moves their legs on a treadmill.
Initial study results showed that training with Lokomat increased patients' fitness compared with standard stretching. The degree of fitness was measured by the patients' percentage of body fat and the peak oxygen uptake by the body during aerobic activity, which is a measure of physical fitness. But so far, researchers have found no improvement in patients' speed of walking.
"This technology takes gait-training to the next level, but we wanted to determine the exact benefit to patients. We found that Lokomat training improves patients' overall fitness considerably, but doesn't necessarily affect their ability to walk any faster," says Peter H. Gorman, M.D., associate professor of neurology at the University of Maryland School of Medicine, chief of the division of rehabilitation medicine and director of the spinal cord injury program at Kernan. Dr. Gorman is also co-director of the Rehabilitation Research Center at Kernan.
Researchers at Kernan have recently opened another study to compare Lokomat therapy with aquatic therapy in a swimming pool. This study, which is funded by the U.S. Department of Defense, is being led by Dr. Gorman at Kernan and conducted in collaboration with the Shepherd Center in Atlanta, Ga.
In addition, Kernan doctors are working with researchers at the University of Maryland R Adams Cowley Shock Trauma Center on various studies, including one examining outcomes after patients experience penetrating spinal cord injuries, such as from bullets or knives. "Unfortunately, these types of injuries are all too common in major urban areas, such as Baltimore," Dr. Gorman says. The University of Maryland Shock Trauma Center treats more than 150 patients a year with spinal cord injury resulting from a variety of causes, including falls, motor vehicle accidents and violent attacks.
The research being done at Kernan complements the hospital's ongoing clinical activities aimed at helping individuals with traumatic and non-traumatic spinal cord injury. The hospital is the largest provider of spinal injury rehabilitation care, both inpatient and outpatient in Maryland. Physicians have special clinics for rehabilitation, pain management, spasticity and urologic care. The hospital offers intensive physical, occupational and recreation therapy, to name just a few of the programs.