Implementation of a gait center training to improve walking ability and vital parameters in inpatient neurological rehabilitation- a cohort study

Stephanie Reichl,Jan Mehrholz,Franz Weilbach

doi:10.1186/s12984-020-00669-3

Abstract

BackgroundMany studies showed that robot-assisted gait training might improve walking of patients after stroke. The question remains whether patients with other neurological diagnoses can improve their ability to walk by training in a gait center. Aim of the present study was therefore to investigate the effects of a gait center training in inpatient neurological rehabilitation on walking ability.MethodsWe implemented a gait center training in addition to individual inpatient rehabilitation. Our primary outcome was walking ability based on the Functional Ambulation Categories (FAC). Our secondary outcomes were vital capacity and blood pressure. We predefined subgroups of patients with ischemic and hemorrhagic stroke and critical illness myopathy (CIM) and polyneuropathy (CIP).ResultsWe included 780 patients from our inpatient rehabilitation center in our cohort study. We analyzed 329 patients with ischemic, 131 patients with hemorrhagic stroke and 74 patients with CIP/ CIM.A large number of patients were able to improve their ability to walk. At the end of rehabilitation, patients with ischemic stroke and FAC 3 = increased theirFAC scores by 5%, FAC 4 = 4% and FAC 5 = 7%. Patients with hemorrhagic stroke and FAC 3 = increased by 5%, FAC 4 = 11% and FAC 5 = 9% and patients with CIP/CIM increased by FAC 3 = 3%, FAC 4 = 22% and FAC 5 = 26%.The largest improvement in walking ability during rehabilitation had patients with a FAC = 1 at baseline who improved by a median of 1.4 FAC points (p < 0.001). After adjusting for the number of gait training sessions, the largest improvement in walking ability during rehabilitation had patients with a FAC = 0 at baseline who improved by 1.8 FAC points (p < 0.001).ConclusionsImplementation of an additional gait center training may significantly improve walking ability in neurological rehabilitation.

Highlights

Many studies showed that robot-assisted gait training might improve walking of patients after stroke
It has been shown that aerobic capacity correlates with gait recovery [8, 9] and it is well known, that patients after stroke are limited in their activities of daily living such as walking due to reduced aerobic capacity [4]
We found differences in patient characteristics between patients with central and peripheral neurological diagnoses

Summary

Introduction

Many studies showed that robot-assisted gait training might improve walking of patients after stroke. The question remains whether patients with other neurological diagnoses can improve their ability to walk by training in a gait center. A gait center training consists of the elements standing and balancing trainer, robot-assisted gait training system and a treadmill with safety belt. With these devices, it is possible for patients to be mobilised vertically at an early stage, depending on their functional capacity and cardiopulmonary endurance [11]. For instance many studies demonstrated the successful use of robotassisted gait training to increase physical activity of inpatient stroke patients [1, 13, 14]. Patients after stroke who are, unable to walk at the beginning of rehabilitation, defined as a Functional Ambulation Categories Score (FAC) of 0 to 2, benefited most from robotassisted gait training in terms of walking ability [1]

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