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Neurology and Neurosurgery

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Rehabilitation and Physical Therapy for TM

Rehabilitation is an integral part of the recovery and treatment of transverse myelitis (TM) patients. The Johns Hopkins Transverse Myelitis Center works closely with the Johns Hopkins Department of Physical Medicine and Rehabilitation to constantly assess and seek effective rehabilitation measures and management.

Transverse myelitis patients are often left with permanent weakness and spasticity, which limits the extent of recovery. Patients often report stiffness, tightness or painful spasms in the buttocks and legs.

The Johns Hopkins Tone Measurement and Biomechanics Lab focuses on quantitative measurements associated with movement disorders. Two of the devices applied are the Lower Limb Spasticity Measurement System (LLSMS) and the GAITRite Portable Walkway System.

What is the Lower Limb Spasticity Measurement System (LLSMS)?

The LLSMS measures qualities of the muscles around the ankle, such as muscle tone.

Lower Limb Spasticity Measurement System
Lower Limb Spasticity Measurement System
  • The subject relaxes prone on an adjustable bed with the tested foot fitted into the LLSMS boot which oscillates across a frequency range for about a five to ten-minute period.
  • The LLSMS oscillates the ankle joint in a sinusoidal motion at a fixed range of motion of five degrees.
  • A computer measures the muscle’s torque response (passive stretch and resistance) as the ankle is moved in the controlled pattern. To ensure that only the passive (non-voluntary and non-reflex) qualities of the muscle are measured, the muscle’s electromyography (EMG) is monitored and recorded using two surface (no needles) electrodes.

What is the GAITRite Portable Walkway System?

The GAITRite Portable Walkway System has been commercially available for several years as an economical tool used internationally to obtain quantitative gait parameters.

  • The walkway is a thin, roll-up vinyl carpet encapsulating an active grid area of two by 12 to 24 feet.
  • The portable pad or carpet lies over a flat, non-slope, solid surface and connects to a laptop with easy setup and operation.
  • The minimum testing area is five feet wide by 35 feet long, allowing for a walking assistant, and five foot acceleration and deceleration zones with added turn-around area. Input data includes the gender, height, weight, and right and left leg lengths (used in normalized computations).
GAITRite Portable Walkway System
GAITRite Portable Walkway System

As the subject ambulates across the walkway, the system captures the relative arrangement, geometry, and applied pressure of each footfall as a function of time and derives objective spatial and temporal parameters along with their coefficient of variation. Data is stored in an Access database and a variety of individual and group analyses and reports are possible along with progress comparisons to self and normal values.

The system can test subjects with or without shoes and allows the use of assistive or ambulatory aids, such as crutches, canes, or walkers. Outcome measures differentiated as right and left include the following:

  • step, cycle, swing, and stance time
  • velocity
  • cadence
  • step and stride length
  • H-H dynamic base, single, and double support
  • toe in and out degrees
  • step/extremity ratio
  • functional ambulation performance (FAP) score

These measures give quantification of walking speed, stride length, step length, symmetry, base width, and consistency from step to step along with the variability from stride to stride (heel-strike of one side to heel-strike of the same side).

To make an appointment or request a consultation, please call 410-502-7099, option 1.

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Maryland Patients

To request an appointment or refer a patient, please contact the Johns Hopkins Transverse Myelitis Center at 410-502-7099, option 1.
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Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337

 

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