These are steps with which we are all intimately familiar, and this machine allows for many different ways of focusing on each part. Learning to walk again requires a substantial amount of muscle strengthening and reconnecting, but mastering the walking pattern itself is also a crucial element.
This is where I believe the Lokomat benefits me the most. I am able to feel the entire step sequence as my legs are manipulated by back-drivable motors through thousands of steps. These motors are sensitive enough to distinguish between the force they apply and the force I apply, and have untold hours of R&D behind them. The motion feels quite natural, and I can even close my eyes and begin to feel that there is no machine at all...! This is excellent for training the mind along with the body.
Perhaps the most helpful part, and certainly the most subtle, is the patterning re-education. The extraordinary amount of repetition, and the consistency of the range of motion that my legs feel are for exactly that purpose: looking ahead to when I am on my feet again, my body itself must know the sequence of muscle firing in order for my brain to be less involved. Presently, it takes considerable effort for me to “find and fire” even the muscles to which I have access.
I expect that over time this method of gait training will assist me in making “smoother” steps in the walker or parallel bars, and by being able to more readily connect to my muscles. The body and nervous system are able to learn so many patterns automatically – think about not needing to look down while climbing stairs, braiding hair, typing, or texting – that I have to think of the extreme repetition as being crucial in recalling the walking motion from the inner-most parts of learned memory in the spinal cord and from the muscles themselves.
I described the Lokomat as a ‘familiar’ machine because, after repeated testing to see if I could demonstrate any amount of muscle response in my legs, I was fortunate to use it many times in the fall of 2013 at the Shepherd Center in Atlanta. Strapping into it again in December of 2014, a year later, was an entirely different experience, however, because my body’s responsiveness has changed immensely.
I am now able to participate to some extent in every stage of the sequence, which was certainly not the case before. Each of the four motors, at each hip and knee joint, can measure the force I exert, and the feedback-display clearly shows my activity.
Pausing here, there is an interesting lesson on the importance of being flexible. At the Shepherd Center, it was presented to us that the Lokomat was the pinnacle of recovery equipment, and indeed, it seemed to offer quite a bit of opportunity for movement retraining. While entertaining the idea of traveling south to the renowned Project Walk in Carlsbad, Calif., where we knew there was a Lokomat, I was introduced to a new world of recovery techniques at SCI-FIT that expanded my understanding of what SCI therapy actually entails.
This shift in awareness is very important, as it allows me to recognize this high-tech machine as a valuable element of my broader healing process. It also reminds me to stay nimble in judgment, because as my situation continues to change, I must be ready to adapt to whatever modalities and opportunities present themselves to me.
As you watch, please note that while it looks miraculously like I’m walking, there is still an incredible amount of progress that I must make to be able to do this on my own.