Body Weight-supported Gait Research Articles

Effectiveness of Body Weight-Supported Gait Training on Gait and Balance for Motor-Incomplete Spinal Cord Injuries: A Systematic Review with Meta-Analysis.

This review aims to analyse the effectiveness of body weight-supported gait training for improving gait and balance in patients with motor-incomplete spinal cord injuries. Relevant articles were systematically searched in electronic databases to identify randomised controlled trials of body weight-supported gait training (either with methods of robotic, manual, and functional electrical stimulation assistance) versus conventional physical therapy or no intervention. Subjects were >16 years-old with motor-incomplete spinal cord injury (AIS C or D). Primary outcomes were gait-related parameters (functionality, endurance, and speed) and balance. Quality of life was included as a secondary outcome. Articles were selected up to 31 December 2023. Fifteen studies met the inclusion criteria (n = 673). Nine studies used robotic assistance, four trials performed manual assistance, one study functional electrical stimulation assistance, and one trial performed the intervention without guidance. Robot-assisted body weight-supported gait training improved walking functionality (SMD = 1.74, CI 95%: 1.09 to 2.39), walking endurance (MD = 26.59 m, CI 95% = 22.87 to 30.31), and balance (SMD = 0.63, CI 95% = 0.24 to 1.02). Body weight-supported gait training is not superior to conventional physiotherapy in gait and balance training in patients with motor-incomplete spinal cord injury. However, body weight-supported gait training with robotic assistance does improve walking functionality, walking endurance, and balance, but not walking speed.

Motion planning and control strategy of a cable-driven body weight support gait training robot

Abstract. In this paper, a cable-driven body weight support gait training robot (C-BWSGTR) that provides patients with partial body weight support as well as a kind of stable gait training driving force was designed; this device enabled those patients to walk again. Firstly, the overall configuration of the C-BWSGTR was determined, and the structural composition and working principle of the robot were established. Secondly, the vector algebra method was applied to carry out the kinematic analysis and establish the mathematical model of the C-BWSGTR. The displacement of each cable during the patient gait training was also calculated. Thirdly, the motion planning of the C-BWSGTR was carried out in stages, using the time–phase distribution relationship based on an S-shaped speed curve. Meanwhile, the displacement, speed, and acceleration of each cable during the patient gait training were calculated and corresponding change curves were generated. Finally, a position servo composite control strategy for the C-BWSGTR was designed by analyzing the robot's dynamic characteristics of the forward channel transfer function. The simulation analysis and prototype experiment in this paper verified that the designed composite position servo control strategy can meet the requirements of the system with respect to stability and a fast response of the system to the loading command.

Body weight-supported gait training for patients with spinal cord injury: a network meta-analysis of randomised controlled trials

Different body weight-supported gait-training strategies are available for improving ambulation in individuals with spinal cord injury (SCI). These include body weight-supported overground training (BWSOGT), body weight-supported treadmill training (BWSTT), and robot-assisted gait training (RAGT). We conducted a network meta-analysis of randomised controlled trials (RCTs) to assess the effect and priority of each training protocol. We searched the PubMed, Cochrane Library, Scopus, and Embase databases from inception to 6 August 2022. The eligibility criteria were as follows: (1) being RCTs, (2) recruiting participants with SCI diagnosis and requiring gait training, (3) comparing different body weight-supported gait training strategies, and (4) involving ambulatory assessments. We conducted a network meta-analysis to compare different training strategies using the standard mean difference and its 95% credible interval. To rank the efficacy of training strategies, we used the P score as an indicator. Inconsistency in network meta-analysis was evaluated using loop-specific heterogeneity. We included 15 RCTs in this analysis. RAGT was had significantly more favourable performance than had the control intervention. The ranking probabilities indicated that the most effective approach was RAGT, followed by BWSOGT, BWSTT, and the control intervention. No significant inconsistency was noted between the results of the direct and indirect comparisons.

A body-weight-supported visual feedback system for gait recovering in stroke patients: A randomized controlled study

ObjectiveThe aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. DesignA single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. SettingIntensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). Participants63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. TreatmentsAll groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group (“control”) underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). Main Outcome MeasuresAbsolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. ResultsSignificant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, η²p = 0.25; F2,126 = 4.7, p-level = 0.007, η²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p’s ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. ConclusionThe proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.

Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke

ObjectiveTo investigate the effects of gait training with body weight support (BWS) on a treadmill versus overground in individuals with chronic stroke. DesignRandomized controlled trial. SettingUniversity research laboratory. ParticipantsIndividuals (N=28) with chronic stroke (>6mo from the stroke event). InterventionsParticipants were randomly assigned to receive gait training with BWS on a treadmill (n=14) or overground (n=14) 3 times a week for 6 weeks. Main Outcome MeasuresGait speed measured using the 10-meter walk test, endurance measured using the 6-minute walk test, functional independence measured using the motor domain of the FIM, lower limb recovery measured using the lower extremity domain of the Fugl-Meyer assessment, step length, step length symmetry ratio, and single-limb support duration. Measurements were obtained at baseline, immediately after the training session, and 6 weeks after the training session. ResultsAt 1 week after the last training session, both groups improved in all outcome measures except paretic step length and step length symmetry ratio, which were improved only in the overground group (P=.01 and P=.01, respectively). At 6 weeks after the last training session, all improvements remained and the treadmill group also improved paretic step length (P<.001) but not step length symmetry ratio (P>.05). ConclusionsIndividuals with chronic stroke equally improve gait speed and other gait parameters after 18 sessions of BWS gait training on either a treadmill or overground. Only the overground group improved step length symmetry ratio, suggesting a role of integrating overground walking into BWS interventions poststroke.

A method to accurately estimate the muscular torques of human wearing exoskeletons by torque sensors.

In exoskeletal robots, the quantification of the user’s muscular effort is important to recognize the user’s motion intentions and evaluate motor abilities. In this paper, we attempt to estimate users’ muscular efforts accurately using joint torque sensor which contains the measurements of dynamic effect of human body such as the inertial, Coriolis, and gravitational torques as well as torque by active muscular effort. It is important to extract the dynamic effects of the user’s limb accurately from the measured torque. The user’s limb dynamics are formulated and a convenient method of identifying user-specific parameters is suggested for estimating the user’s muscular torque in robotic exoskeletons. Experiments were carried out on a wheelchair-integrated lower limb exoskeleton, EXOwheel, which was equipped with torque sensors in the hip and knee joints. The proposed methods were evaluated by 10 healthy participants during body weight-supported gait training. The experimental results show that the torque sensors are to estimate the muscular torque accurately in cases of relaxed and activated muscle conditions.

1D11 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 免荷装置の開発と評価(OS6:医療機器・再生医療製品のレギュラトリーサイエンス)

1D11 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 免荷装置の開発と評価(OS6:医療機器・再生医療製品のレギュラトリーサイエンス)

2G16 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 短下肢装具部の開発(GS9-1:人間支援(1))

2G16 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 短下肢装具部の開発(GS9-1:人間支援(1))

Effects of FES-Ambulation Training on Locomotor Function and Health-Related Quality of Life in Individuals With Spinal Cord Injury

The combination of body weight-supported gait training with functional electrical stimulation (FES) may provide the optimal stimulus for improving overground walking after spinal cord injury (SCI). This potential benefit is likely due to the combination of specificity with the maximization of muscle contractions. To investigate the effects of 12 weeks of FES-ambulation on overground walking and health-related quality of life (HRQOL) in individuals with SCI. Six individuals (60.5 ± 13.2 years) with SCI (C4-L3; AIS D; 9.3 ± 12.0 years post injury), completed a thrice-weekly, 12-week FES-ambulation training program. Locomotor function was assessed via the Walking Index for Spinal Cord Injury II (WISCI II), the 6-minute walk test (6MWT), the 10-meter walk test (10MWT), and the body-weight support required during training. HRQOL was assessed via the Short Form-36, the Perceived Stress Scale, and the Center of Epidemiological Studies for Depression scale. Participants showed significant improvements in the 6MWT (223.6 ± 141.5 m to 297.3 ± 164.5 m; P = .03), the required body weight support (55.3% ± 12.6% to 14.7% ± 23.2%; P = .03), and a nonsignificant trend toward an increase in walking speed during the 10MWT (0.69 ± 0.4 m/s to 0.9 ± 0.5 m/s; P = .08) following the training program. Four participants showed improvements on the WISCI II (1-4 points). Participants also showed a decrease in the Short Form-36 pain score (6.5 ± 1.2 to 5.0 ± 1.7; P = .04) and an increase in the overall mental health score (47.8 ± 12.6 to 54.2 ± 6.7; P = .04). FES-ambulation was associated with enhanced overground walking in individuals with AIS D SCI, reduced pain, and improved mental health.

Overground Body-Weight-Supported Gait Training for Children and Youth with Neuromuscular Impairments

ABSTRACTThe aim of this investigation was to determine if body-weight-supported (BWS) overground gait training has the potential to improve the walking abilities of children and youth with childhood onset motor impairments and intellectual disabilities. Eight participants (mean age of 16.3 years) completed 12 weeks of BWS overground gait training that was performed two times a week. BWS was provided during the training sessions by an overhead harness system that rolls overground. There was a significant improvement in the preferred walking speed after the training (p < .01; pre = 0.51 ± 0.2 m/s; post = 0.67 ± 0.3 m/s; Cohen's d = 0.80) and cadence (p = .04; pre = 37 ± 7 steps/min; post = 43 ± 8 steps/min; Cohen's d = 0.94). Our results indicate that overground BWS gait training may be an effective treatment strategy for improving the preferred walking speed of children and youth with motor impairments.

Design and Evaluation of the AIRGAIT Exoskeleton: Leg Orthosis Control for Assistive Gait Rehabilitation

This paper introduces the body weight support gait training system known as the AIRGAIT exoskeleton and delves into the design and evaluation of its leg orthosis control algorithm. The implementation of the mono- and biarticular pneumatic muscle actuators (PMAs) as the actuation system was initiated to generate more power and precisely control the leg orthosis. This research proposes a simple paradigm for controlling the mono- and bi-articular actuator movements cocontractively by introducing a cocontraction model. Three tests were performed. The first test involved control of the orthosis with monoarticular actuators alone without a subject (WO/S); the second involved control of the orthosis with mono- and bi-articular actuators tested WO/S; and the third test involved control of the orthosis with mono- and bi-articular actuators tested with a subject (W/S). Full body weight support (BWS) was implemented in this study during the test W/S as the load supported by the orthosis was at its maximum capacity. This assessment will optimize the control system strategy so that the system operates to its full capacity. The results revealed that the proposed control strategy was able to co-contractively actuate the mono- and bi-articular actuators simultaneously and increase stiffness at both hip and knee joints.

Poststroke Spasticity Management

Poststroke spasticity (PSS) is a common complication associated with other signs and symptoms of the upper motor neuron syndrome, including agonist/antagonist co-contraction, weakness, and lack of coordination. Together, they result in impairments and functional problems that can predispose to costly complications. The goal of PSS management should take into consideration not only reduction of muscle hypertonia but also the impact of PSS on function and well-being. Therapeutic interventions focus on peripheral and central strategies, such as physical techniques to increase muscle length through stretching and pharmacological modulation. Although there are few comparative studies on the superiority of one method over another, it appears that optimal management of PSS involves a combined and coordinated compendium of therapies that encompass cost-effective pharmacological and surgical interventions, along with rehabilitative efforts. Spasticity, commonly defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome,”1 is a common complication of stroke. It contributes to the impairments and disabilities that negatively impact functional recovery. Consequently, PSS, along with weakness and lack of coordination, result in gait abnormalities and problems with arm use. In addition to functional limitations, spasticity, when inappropriately treated, may lead to reduced quality of life, increased pain, and joint contractures. Three community-based studies that followed-up stroke survivors for 3 to 12 months reported an incidence of PSS between 17% and 43%.2–4 Certain factors are recognized as predictors of PSS: stroke lesions in the brain stem; hemorrhagic stroke and younger age;5 and severe paresis and hemihypesthesia at stroke onset.3 To quantify the full impact of PSS, assessment should include a measure of passive stretch, volitional movement, and active/passive function.6,7 The benefit of …

9I-02 空気圧人工筋を用いた免荷式歩行訓練システムの開発(OS-7(2) 義足と下肢装具の歩行メカニクス)

9I-02 空気圧人工筋を用いた免荷式歩行訓練システムの開発(OS-7(2) 義足と下肢装具の歩行メカニクス)

Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury : a systematic review

To evaluate the effect of body weight-supported gait training on restoration of walking, activities of daily living, and quality of life in persons with an incomplete spinal cord injury by a systematic review of the literature. Cochrane, MEDLINE, EMBASE, CINAHL, PEDro, DocOnline were searched and identified studies were assessed for eligibility and methodological quality and described regarding population, training protocol, and effects on walking ability, activities of daily living and quality of life. A descriptive and quantitative synthesis was conducted. Eighteen articles (17 studies) were included. Two randomized controlled trials showed that subjects with injuries of less than one year duration reached higher scores on the locomotor item of the Functional Independence Measure (range 1-7) in the over-ground training group compared with the body weight-supported treadmill training group. Only for persons with an American Spinal Injury Association Impairment Scale C or D was the mean difference significant, with 0.80 (95% confidence interval 0.04-1.56). No differences were found regarding walking velocity, activities of daily living or quality of life. Subjects with subacute motor incomplete spinal cord injury reached a higher level of independent walking after over-ground training, compared with body weight-supported treadmill training. More randomized controlled trials are needed to clarify the effectiveness of body weight-supported gait training on walking, activities of daily living, and quality of life for subgroups of persons with an incomplete spinal cord injury.

A Novel Mechatronic Body Weight Support System

A novel mechatronic body weight support (BWS) system has been developed to provide precise body weight unloading for patients with neurological or other impairments during treadmill training. The system is composed of a passive elastic spring element to take over the main unloading force and an active closed-loop controlled electric drive to generate the exact desired force. Both force generating units, the passive spring and the active electric drive, act on the patient via a polyester rope connected to a harness worn by the patient. The length of the rope can be adjusted with an electric winch to adapt the system to different patient sizes. The system is fully computer controlled. At unloading loads of up to 60 kg and walking speeds of up to 3.2 km/h, the mean unloading error and the maximum unloading error of the presented BWS system was less than 1 and 3 kg, respectively. The performance was compared with those of two purely passive BWS systems currently being used by most other rehabilitation groups. This comprised counterweight systems and static BWS systems with fixed rope lengths. Counterweight systems reached mean and maximum unloading errors of up to 5.34 and 16.22 kg, respectively. The values for the static BWS were 11.02 kg and 27.67 kg, respectively. The novel mechatronic BWS system presented in this study adjusts desired unloading changes of up to 20 kg within less than 100 ms. Thus, not only constant BWS, but also gait cycle dependent or time variant oscillations of the desired force can be realized with high accuracy. Precise and constant unloading force is believed to be an important prerequisite for BWS gait therapy, where it is important to generate physiologically correct segmental dynamics and ground reaction forces. Thus, the novel BWS system presented in this paper is an important contribution to maximize the therapeutic outcome of human gait rehabilitation.

The Effectiveness of Body Weight-Supported Gait Training and Floor Walking in Patients With Chronic Stroke

Peurala SH, Tarkka IM, Pitkänen K, Sivenius J. The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Objective To compare body weight-supported exercise on a gait trainer with walking exercise overground. Design Randomized controlled trial. Setting Rehabilitation hospital. Participants Forty-five ambulatory patients with chronic stroke. Interventions Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GT stim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20min), and they received additional physiotherapy 55 minutes daily. Main Outcome Measures Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. Results The mean walking distance using the gait trainer was 6900±1200m in the GT stim group and 6500±1700m in GT group. In the WALK group, the distance was 4800±2800m, which was less than the walking distance obtained in the GT stim group ( P=.027). The body-weight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT ( P<.001), 6MWT ( P<.001), MMAS ( P<.001), dynamic balance test time ( P<.001), and test trip ( P=.005) scores improved; however, no differences were found between the groups. Conclusions Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients’ motor performance remained improved at the follow-up.