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Rehabilitation strategies for improving walking ability after neurological injury. We are are studying ways that individuals with spinal cord injury or stroke can perform therapeutic exercises on their own, without direct assistance from physical therapists. Our long-term goal is to develop inexpensive at-home exercise machines that patients can use to improve their walking ability.

Self-Assisted Stepping for Neurologic Rehabilitation. Recent scientific evidence indicates that task-specific active exercise can greatly improve motor recovery after stroke or spinal cord injury. Traditional physical therapy techniques rely on patients performing motor tasks very slowly with therapists providing manual assistance. We believe that giving the patient control over the timing and amount of physical assistance can increase neuromuscular recruitment and promote greater activity-dependent plasticity. Allowing patients to provide their own 'self-assistance' should also enable them to perform task-specific active exercise at normal movement speeds. This is important because recent studies have demonstrated that faster movement speeds during rehabilitation lead to better functional gains in motor recovery. We are studying individuals with spinal cord injury and stroke as they perform a stepping motion on a commercially available exercise machine (NuStep TRS 4000, a recumbent stepper designed for cardiovascular exercise). The stepping machine has handles and pedals that are contralaterally coupled, allowing subjects to use their own arms to assist their lower limbs during stepping. The basic premise we are testing is that self-assisted rehabilitation will enhance motor recovery compared to externally-assisted rehabilitation.