Underwater-treadmill improves mobility following spinal-cord injury

Jul 27 2011

The result of research often is shown in hard and fast metrics. For Janette Rodgers, the only metric she cares about is that her wheelchair, once her prison day in and day out, now sits empty 90 percent of the time— in large part because of the hours she spent in 270 gallons of water.

After suffering a broken neck and spinal-cord damage in a car accident in 2007, Rodgers, 53, was nearly taken off life-support. Later, doctors told her she would never walk again. A year later, she was a participant in Dr. Sandra Stevens' underwater-treadmill study at Middle Tennessee State University where she gradually managed to take a few steps with assistance.

Today, Rodgers' husband, Terry, watches as his wife walks 500 feet every day to the mailbox at their home in Rockvale, Tenn.

"She pretty much does all the housework now—dishes, laundry, cleaning floors—and she keeps up with the shopping a lot better. There's a big improvement in her outlook," Terry Rodgers says, as he glances over at his wife going through her underwater paces. "I used to do most of it, and I didn't care for it," he added with a grin.

"When I first started therapy, I was out of my power chair maybe 10 percent of the time," Janette Rodgers adds without breaking her rhythm. "Today I'm out of it 90 percent of the time. It has really made a difference in my mental outlook. In the four years since my accident, my doctor says he has never seen such improvement."

"If you quit trying, you'll quit improving," Stevens yells over the whirring of the treadmill.

"It's relatively new technology," said Dr. Don Morgan, MTSU health and human performance professor, who brought the treadmill to the university a few years ago. Morgan and his graduate students, including Stevens, began their initial work with the treadmill thanks to funding from the National Institutes of Health.

After Rodgers finished her therapy session, got dressed and walked out the door with her husband, Stevens sat down and reiterated what she preaches so often.

"It's a self-fulfilling prophecy. If we constantly tell patients that you'll improve over a year then level off and that will be it, then after that one year the patient will stop trying so hard. They think that's about as good as they're going to get."

Stevens graduated from MTSU in December of 2010 with a doctorate in human performance. Throughout the previous year, she worked with 12 people who had severe spinal-cord injuries, utilizing the controlled speed of the underwater treadmill. A training session with each smaller group lasted eight weeks, three sessions a week. When the study came to an end, Rodgers wanted to continue her therapy. Stevens agreed to work with her.

"I have a couple of people who won't quit," Stevens said. "A couple of them, like Janette, are going on a year of training."

During her study, Stevens said she looked for leg strength, balance, preferred walking speed, rapid- walking speed, the amount of distance they could cover in six minutes and how many steps they took in their own environment in one week.

"What I found that they demonstrated as a group was a 57 percent increase in leg strength, 39 percent improvement in balance, 34 percent improvement in preferred walking speed, 61 percent improvement in rapid-walking speed, 82 percent improvement in a six-minute walking distance and a 121 percent increase in the number of steps they took in their own environment," Stevens said, as she referred to her notes on a clipboard. "Everybody had some measure of improvement."

Participants demonstrated greater typical cardiac responses to training as well, Steven said. As training increased, the more muscles worked to increase the blood flow to the heart and the nerves in the muscles sent signals to the brain, which triggered the appropriate cardiac response to exercise.

Most everyone reported improvement in mobility, greater independence, better general health and improved mental well-being, Stevens noted. Some said they could climb stairs without assistance. Some said they could reach over and pick up something off the floor, including themselves if they fell. One participant who had leg braces said he stopped wearing them because he had built up so much muscle in his legs, the braces no longer fit.

"Then he realized he didn't need them—greater weight loss, decreased stress," Stevens said excitedly.

"Janette said she started dreaming of herself as a walker," Stevens recalled. "She said before the accident she walked in her dreams. After the accident, she lost the ability even in her dreams and was in a wheelchair in her dreams. During [the therapy] she started walking again in her dreams."

Was there a relationship between the kind and rate of improvement and the person's attitude toward wanting to improve?

"Yes, to a certain extent," Stevens answered. "But everyone in the study had a good attitude because they wanted to improve. These were all people who had exhausted the resources they had. There is a portion of the population who become content with where they are. They will become the best wheelchair athlete they can be—they have made the modifications, and their life is happy and content. And that's an appropriate choice. But there are some people who are not content. There should be resources for those people as well. I was working with a group of extremely motivated people.

"I was surprised. I went into it expecting that people could get better," Stevens continued. "But I didn't expect over a hundred percent improvement on steps in your own environment. Ultimately, regardless of whether or not balance or strength improves or whatever the component is, if the results are that you're walking more in your own environment, that's the measure we want to look at. And the implication for cardiovascular health—I mean the decreases in so many health consequences related to a sedentary lifestyle—that is a very meaningful and clinically relevant outcome."

Stevens said in a perfect world it would be great to have the funds to put an underwater treadmill in an out-patient setting.

"It doesn't take a skilled therapist to oversee treatment," she said. "Just someone to open the door, get the water in and they're good to go. This needs to be in a community-center environment to have the greatest impact." But would the results be the same as in a clinically controlled setting?

The beauty of the whole thing is that it's water," Stevens said. "It's not complicated and not that technical. If you could submerge a treadmill in a pond, they could do it. Something that provides this kind of improvement at hardly any expense … this is where you want health care to go."

Source: Middle Tennessee State University