Research with Underwater Treadmill is Breakthrough for Victims of Spinal-Cord Injuries
Source Newsroom: Middle Tennessee State University
Newswise — It is a common assumption that it takes years to realize any measurable benefits from scientific research. It’s a marvel, therefore, to see an almost immediate payoff without wading through complicated tomes or deciphering squiggly creatures through microscopes. The payoff is a dramatic upturn in a person’s quality of life.
Following a plane crash, Jim Harris didn’t walk for two years. Today, with effort, he is walking. After a terrible fall, Bob Moody could only be on his feet for a couple of minutes. Now he’s taking 20-minute walks. As the result of a horrible automobile accident, Janette Rodgers was told she’d never walk again. In fact, she was nearly taken off life-support. Now she’s walking and improving her speed.
These recoveries and subsequent improvements have been possible, in no small part, because Sandra Stevens, a physical therapist, put these people through their paces on an underwater treadmill inside a fiberglass tank that holds 270 gallons of water—all part of her doctoral research at Middle Tennessee State University. Her research subjects were people who had suffered severe spinal-cord trauma.
Previously, graduate students in MTSU’s exercise science program utilized the underwater treadmill to help children with cerebral palsy increase muscle strength and improve mobility. The results were encouraging.
“It’s relatively new technology,” commented Dr. Don Morgan, MTSU health and human performance professor, who initially brought the treadmill to the Murfreesboro campus several years ago. “It’s been used by athletic teams and for older folks with arthritis. But it had never been used with children with CP.
Although water therapy had been used with physically challenged children in swimming pools, you can’t control the water height in pools. And with a treadmill you can control the speed.” Morgan and his students began their initial work with the treadmill thanks to funding from the National Institutes of Health.
“After watching the kids with cerebral palsy, I thought there were a lot of other populations that could benefit from this kind of therapy,” Stevens said.
Stevens worked with Rodgers, Harris, Moody and others for eight weeks during the fall semester, with each participant meeting two or three times a week.
“I looked at leg strength, balance, daily walking behavior, walking speed and endurance,” Stevens said. “Some of these folks could only walk for a minute then they would have to sit. When they started walking in the tank, the minimum time I set was five minutes of walking. They all were able to do that.”
For spinal-cord injuries, walking in water is the ideal place because people with this particular injury have a blunted cardiovascular response to any exercise, Stevens explained. The nerves that trigger the heart to beat faster are also impaired nerves that trigger walking. The low muscle tone in their legs coupled with their inability to increase their heart rate result in very poor endurance. It’s a repetitive and nonproductive cycle. Walking in water produces greater blood flow, which increases cardiovascular activity, she said.
“They experience a real psychological boost,” Stevens said. “At first they feel like they’re in the way. After trying initially [to walk], they say, ‘What’s the point—I won’t be able to walk anyway.’”
Popular ambulation therapies include placing the subject in a harness over a treadmill and using robotics to move the person’s legs, Stevens pointed out. “In the water tank … you’re responsible for moving your legs. It’s not a passive activity anymore.”
Toward the end of the study, Stevens said her volunteers were walking up to four trials at eight minutes each. “So they’ve gone from four or five minutes of walking to 32 or 34 minutes. That’s a big improvement.”
When Bob Moody started, he was walking at 1.5 miles an hour in the tank. Now he’s up to 2.5 miles an hour, which is just about a normal gait pattern, Stevens said. Jim Harris started at .33 miles an hour, and “he’s over a mile per hour now, so he’s more than tripled his speed,” Stevens noted. “And Jim was not able to stand independently at all. Now he can stand alone for almost a minute without holding on to anything.” Janette Rodgers went from a wheelchair to a walker with a seat. “So she can push it or sit down and scoot or have somebody push her. She’s doing great at walking in the tank. It’s pretty exciting.”
Stevens said she has given each participant an exercise regimen that they can continue to practice at home. “I think as they gain confidence, they’re changing how they do everything in their daily life. As they challenge themselves everyday, it contributes to their improvement,” she said.
In addition to being an adjunct instructor in exercise science at MTSU, Stevens is a temporary faculty member at Tennessee State University in Nashville in the College of Health Science. She earned her bachelor’s degree at the University of Kansas and Master of Science degree at MTSU. She hopes to complete her doctorate in human performance at MTSU this summer.
In 2005, Jim Harris, 57, was injured in a plane crash and suffered a spinal burst that severed pieces of his spinal cord. His doctors said he would never walk again. The underwater treadmill therapy has helped him defy those doctors.
“Even though the medical professionals at the time, said, ‘Well you’ll never get up and walk again,’ Every time I get up, I’m reminded, ‘Ha ha, proved you wrong,’” Harris said.
Harris heard about the underwater therapy program when Sandra Stevens gave a presentation at Vanderbilt Stallworth Rehabilitation Center.
Walking was a challenge at first, Harris said, but now he’s more comfortable walking in the underwater-treadmill tank.
“There’s been an increase in stability and control,” he noted.
In the beginning, Harris was walking three 5-minute cycles at about .28 miles an hour on the treadmill. Now he is walking four 8-minute cycles for more than a mile an hour. The underwater treadmill, Stevens said, gives buoyancy, resistance for strengthening, sensory feedback and slows down reaction time so that his body can process his actions.
“His stride looks more like a normal walking pattern than when he started,” Stevens said. “The quality of his gait has improved.”
Gerry Harris, Jim’s wife, said she thinks Jim’s increase in mobility helps his mental state, too, and he likes coming to the therapy sessions for more than just exercise.
Harris’ ultimate goal is to be able to fly planes again, he said. A year after the plane crash he flew with another pilot, and he said it felt good.
Jim’s injury has not been a hindrance, he said, but has created additional hurdles that are a part of life. The physical exercise he gets from walking on the underwater treadmill has helped him be less fearful about doing other tasks.
“As long as you just have something that you’re reaching for, you always push a little harder,” Harris said.
Sometimes appearances can be more than deceiving. They can outright lie.
Watching Bob Moody prepare for his underwater-treadmill treatment, under the direction of doctoral student Sandra Stevens, might lead one to think that he is a hopelessly broken man. He struggles to sit down on the bench outside the treatment tank, to adjust his shoes and, occasionally, to draw a breath. The lie is completed by the overly careful steps he takes to enter the tank. When the treadmill begins to rotate, the truth about him and the strength of his body become apparent as he pushes himself to walk faster and longer.
Before becoming significantly paralyzed after falling in a hotel in Hong Kong two years ago, Moody was extremely active and travelled around the world. It is his personal philosophy of turning obstacles into opportunities that has enabled his body to respond positively to the remarkable underwater-treadmill therapy.
“When I first started the program, I could barely get around when I went shopping,” he said. “Now I can go 20 minutes before I need to sit.”
In the first 10 weeks of treatment, he has improved his over-ground walking speed by 20 percent and increased his workout walking speed by 50 percent, while also bolstering his endurance. His overall heightened physical activity has improved the mobility of his arms and hands. It is only recently, for example, that his ability to grip and open jars has returned.
At this point, no one knows the limitations or potential of spinal-cord healing. In Bob Moody’s case, no one knows what it would take to get him to give up trying. Merely settling for what is … is not in his makeup.
“The therapy has made it so that I can go to the recreation center pool in town and train on my own,” Moody added. “I’m strong enough to go it on my own and work out.”
Janette Rodgers of Rockvale, Tenn., suffered a broken neck and spinal cord damage after a car accident in May 2009. She was rushed to Vanderbilt Medical Center, diagnosed with a complete spinal cord injury and told she would never walk again.
"If I were to listen to what they had told me, I'd still be laying in the hospital bed or in a nursing home," Rodgers, 52, said. "With spinal cord injuries you're like a child, you have to learn to do everything again. If you don't keep moving something, it'll quit working."
Six months later, Rodgers is able to walk with aid, and her injury continues to show improvement during her participation in Sandra Stevens' underwater treadmill study.
Rodgers learned about Stevens' research study while attending physical therapy. "One of the ladies there said they were doing research at MTSU and if I was interested, I should check on it. I called and we came over to talk with Sandy and look at the tank, and then we just started," said Rodgers. "I thought this will help me get better faster."
Rodgers had done pool training as part of her physical therapy before, but she says she has not seen results as dramatic as those in Stevens' study. "I've noticed more of an improvement in my walking since I've been doing the treadmill underwater than I have anything."
Rodgers maintains a positive outlook on her future and says the exercise has increased her feeling of well-being. With the underwater-treadmill study now completed, Rodgers plans to resume her traditional physical therapy schedule and possibly begin water aerobics at the YMCA.