Abstract
Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.
Highlights
Employing treadmill training in gait rehabilitation can be of significant help in achieving functional ambulation in patients with neurological damage, including stroke
The mildness of SSR changes in comparison to healthy controls (HC) depended on the fact that the percent gait cycle duration was longer in the patients with stroke compared to HC
There were no significant differences between treadmill gait training (TGT) and AlterG groups, as well as no pair-wise lower limbs differences were appreciable between the patient groups
Summary
Employing treadmill training in gait rehabilitation can be of significant help in achieving functional ambulation in patients with neurological damage, including stroke. Treadmill training augments the ability to walk independently of patients with stroke, in the short term, and provide them with higher walking speed and walking endurance as compared to traditional overground gait training. BWSTT can alleviate post-stroke survivors’ weight bearing and effort (and physiotherapist’s effort) during gait training, allowing the patient to walk when muscle strength and postural control are still nonsufficient for functional ambulation. They may allow for mobilization and training early [7,8]. These systems implement differential air pressure technology using a chamber to reduce the weight of an individual while walking up to 100% of the original body weight, instead of using a body-suspension harness system
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