Body Weight-supported Treadmill Research Articles

Repetitive Intermittent Hypoxia and Locomotor Training Enhances Walking Function in Incomplete Spinal Cord Injury Subjects: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial

Incomplete spinal cord injuries (iSCI) leave spared synaptic pathways below the level of injury. Intermittent hypoxia (IH) elicits plasticity in the spinal cord and strengthens spared synaptic pathways, expressed as respiratory and somatic functional recovery in experimental animals and humans with iSCI. This study is a randomized, triple-blind, two-arm parallel clinical trial performed in Santiago, Chile. We compared the effects of a 4-week protocol of IH combined with body weight-supported treadmill training (BWSTT), with continuous normoxia (Nx) and BWSTT on 10-meter walk test (10MWT), 6-minute walk test (6MWT), and timed up and go (TUG) test in American Spinal Injury Association C and D individuals with iSCI. Subjects received daily IH (cycling 9%/21% O2 every 1.5 min, 15 cycles/day) or continuous Nx (21% O2) combined with 45 min BWSTT for 5 consecutive days, followed by IH/Nx 3 × per week (3 × wIH/Nx) for 3 additional weeks. Subjects were assessed at day 5, weekly from weeks 2-4, and at a 2-week follow-up. Daily IH plus BWSTT enhanced walking speed, expressed as decreased 10MWT time at day 5 versus baseline (IH: -10.2 ± 3.0 vs. Nx: -1.7 ± 1.7 sec, p = 0.006), and walking endurance expressed as increased 6MWT distance at day 5 versus baseline (IH: 43.0 ± 10.7 vs. Nx: 6.1 ± 3.4 m, p = 0.012), but not TUG time. Further, 3 × wIH maintained the daily IH-induced walking speed, and enhanced the daily IH-induced walking endurance, which is maintained up to the 2-week follow-up. We conclude that daily IH enhances walking recovery in subjects with iSCI, confirming previous findings. Moreover, 3 × wIH prolonged or enhanced daily IH-induced walking speed and endurance improvements, respectively, up to 5 weeks post-daily IH. Repetitive IH may be a safe and effective therapeutic alternative for persons with iSCI.

Interappendicular Neurological Coupling During Various Locomotor Tasks In Persons With Spinal Cord Injury

It has been suggested that neurological coordination between the upper and lower limbs during human locomotion is accomplished largely via subcortical centers, but the functional implications of spinal limb coupling during walking have not been fully explored. However, emerging evidence exists showing that active arm movements during locomotion can augment leg muscle activity in persons with paralysis. PURPOSE: To determine the influence of upper limb actions on muscle activity during various locomotor tasks in persons with spinal cord injury (SCI). METHODS: Six (n = 5 male, 1 female) persons (31 ± 8 yr, 69.2 ± 9.3 kg, 1.78 ± 0.09 m) with SCI (4 cervical & 2 thoracic injuries) were suspended above a treadmill via a body weight support (BWS) system which allowed for partial loading of the lower body (45% body weight). Therapists located on the side of the treadmill manually moved their legs through the gait pattern at a set cadence (85 steps/min) while the treadmill moved at 1.6 mi/hr. During body weight support treadmill training (BWSTT) participants swung their arms (Swing), held parallel bars located on the side of the treadmill (Hold) and held in a similar yet unsupported position as in the parallel bar condition (Sham). Plantar forces (Pf) and surface electromyography (sEMG) of six lower limb muscles was measured and averaged for 12 steps during each of the upper body conditions. RESULTS: Maximal sEMG of the medial gastrocnemius was significantly greater (p=.04) in Swing (18.4 ± 13.1) compared to Hold (12.9 ± 15.9) just before initial contact, when mechanical loading of the legs was not different. No other sEMG measures used for statistical analysis yielded significant differences, but case comparison of participants indicates that differences in individual responses could be largely explained by injury characteristics. CONCLUSION: Results suggest that active arm movement during locomotion could augment leg muscle activity in persons with SCI, and that the influence of arm actions differs based on neurological level and extent of injury. Therefore, in persons with paralysis the actions of the arms during walking should be considered in both rehabilitation and community contexts.

Metabolic and Cardiovascular Effects of Body Weight Support Treadmill Running

PURPOSE: To determine the association between body weight support (%BWS) and velocity on cardiorespiratory variables during body weight supported treadmill running. METHODS: Fifteen apparently healthy, male recreational runners (age = 23 ± 2yr, height = 1.79 ± 0.05m, mass = 74.4 ± 11.1kg, BMI = 23.2 ± 2.7 kg·m-2, VO2max = 50.9±7.5 mL·kg-1·min-1) visited the laboratory on two separate occasions. Visit 1 comprised of a graded incremental treadmill test to quantify VO2max. Visit 2 comprised of 12 x 4 min running trials at 3 individually calculated velocities (equivalent to 60, 70 and 80% VO2max) and 4 gravitational loads (40, 60, 80, and 100 %BWS) with 2 minutes recovery between trials. A Latin Square design was used to randomize trial order. Oxygen consumption (VO2) and heart rate (HR) data were averaged during the last minute of each stage. Kolmogorov-Smirnov tests quantified normality and log transforms were applied to non-normally distributed data sets (VO2). A 2 factor (velocity x %BWS) repeated measures ANOVA was performed with post-hoc significance (P<0.05). A multiple regression analysis was performed to predict VO2 from treadmill velocity (measured in km·h-1), %BWS and subject body mass (BM). RESULTS: The multiple regression analysis significantly predicted VO2 (F(3,371)=396.0, p<0.0005, R2=0.762). The following equation accurately predicted VO2 when running in a lower body positive pressure (LBPP) treadmill using 3 independent variables (SEE=3.51 mL·kg-1·min-1):VO2 = (1.814 x Velocity) + (0.202 x %BWS) - (0.126 x BM) + 3.448. Increasing velocity had a significant effect on VO2 (F=81.711, P <0.001) and HR (F=92.665, P<0.001). Increasing %BWS had a significant effect on VO2 (F=267.37, P<0.001) and HR (F=146.520, P<0.001). A significant interaction existed between velocity and %BWS on VO2 (F=5.526, p< 0.001) and HR (F=4.530, p<0.001). CONCLUSION: An equation was created using a multiple regression analysis to accurately predict VO2 while running in a LBPP device based off velocity, %BWS and BM. Clinicians and athletic trainers can use this equation to more accurately prescribe exercise intensity based on VO2 for individuals training on a LBPP treadmill. This should assist in developing an individualized exercise program to enhance the rehabilitation and training process.

Bodyweight-supported treadmill training for retraining gait among chronic stroke survivors: A randomized controlled study

ObjectiveTo evaluate the role of bodyweight-supported treadmill training (BWSTT) for chronic stroke survivors. DesignProspective, randomized controlled study. MethodsPatients with a first episode of supratentorial arterial stroke of more than 3months’ duration were randomly allocated to 3 groups: overground gait training, treadmill training without bodyweight support, and BWSTT (20 sessions, 30min/day, 5days/week for 4weeks). The primary outcome was overground walking speed and endurance and secondary outcome was improvement by the Scandinavian Stroke Scale (SSS) and locomotion by the Functional Ambulation Category (FAC). We analyzed data within groups (pre-training vs post-training and pre-training vs 3-month follow-up) and between groups (at post-training and 3-month follow-up). ResultsWe included 45 patients (36 males, mean post-stroke duration 16.51±15.14months); 40 (89.9%) completed training and 34 (75.5%) were followed up at 3months. All primary and secondary outcome measures showed significant improvement (P<0.05) in the 3 groups at the end of training, which was sustained at 3-month follow-up (other than walking endurance in group I). Outcomes were better with BWSTT but not significantly (P>0.05). ConclusionBWSTT offers improvement in gait but has no significant advantage over conventional gait-training strategies for chronic stroke survivors.

Intermittent Hypoxia Does not Elicit Memory Impairment in Spinal Cord Injury Patients.

There is a critical need for new therapeutic strategies to restore motor function in patients with spinal cord injuries (SCIs), without unwanted effects. Intermittent hypoxia (IH) induces plasticity in spared synaptic pathways to motor neurons below the level of injury, which can be harnessed to elicit motor recovery in incomplete SCI patients. However, there is conflicting evidence regarding the effects of IH on memory function. The aim of this study was to assess episodic verbal and visual memory function with the Complutense verbal learning test (TAVEC) and the Rey-Osterrieth Complex Figure Test (ROCF), respectively, before and after a 4-week protocol of repetitive IH combined with body weight-supported treadmill training (BWSTT) in incomplete ASIA C and D SCI subjects. Subjects received either IH (cycling 9%/21% FiO2 every 1.5 min, 15 cycles per day) or continued normoxia (Nx, 21% FiO2) combined with 45 min of BWSTT for 5 consecutive days, followed by 3 times per week IH and BWSTT for 3 additional weeks. ROCF Z scores between IH plus BWSTT and Nx plus BWSTT were not significantly different (p = .43). Compared with baseline, IH and BWSTT group showed a significantly greater (p < .05) verbal memory performance for immediate, short-term, and long-term recall; however, it was not different from Nx plus BWSTT group in all verbal memory components (p > .05). Our results suggest that a 4-week protocol of moderate IH does not elicit visual or verbal memory impairment. Thus, repetitive IH may be a safe therapeutic approach to incomplete spinal cord injury patients, without deleterious cognitive effects.

Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation

BackgroundIntensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase. ObjectiveTo examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure. DesignA prospective, repeated measures design was used. MethodsTen inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial. ResultsStride length, cadence, and paretic single limb support increased with faster walking speeds (p⩽0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p⩽0.001). RPE also was greatest at the fastest compared to two slowest speeds (p<0.05). ConclusionsDuring the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.

Effects of body weight-supported treadmill training combined with ball-kicking on balance and gait of subacute stroke patients

Objective: This study focused on subacute stroke patients who were asked to kick a ball while walking on a treadmill. The aim of the study was to determine the effect of a body weight-supported treadmill training (BWSTT) combined with ball-kicking on muscle strength, balance, and gait. Design: Single blind, randomized controlled trial. Methods: Twenty stroke patients who volunteered to participate in this study were randomly assigned to either the BWSTT combined with ball-kicking (BWSTT-BK; 10 participants) group or the BWSTT group (10 participants). Participants in the BWSTTBK group performed treadmill walking combined with simultaneous ball-kicking for 30 minutes daily for 5 weeks. Participants from the BWSTT group performed only treadmill walking. The muscular strength, balance, and gait ability were measured before and after the 5-week training. To assess for muscular strength, a digital muscle tester was used to measure hip flexor, knee extensor, and dorsiflexor strength. To assess for balance, the Berg Balance Scale (BBS) and Timed Up and Go Test (TUG) was used. To assess for gait, the 10 meter walk test (10MWT) and Functional Gait Assessment (FGA) was used. Results: The BWSTT-BK group showed significantly improved muscular strength, balance, and gait according to BBS, TUG, 10MWT, FGA, and digital muscle testing scores compared to the BWSTT group (p

High intensity body weight support treadmill training induces long-term walking performance improvement without spasticity increase after chronic incomplete spinal cord injury

Body Weight Support Treadmill Training (BWSTT) has shown walking improvement after incomplete spinal cord injury (SCI) but its effect on spasticity remains unaddressed. The aim of this study was to assess the BWSTT effects on both walking performance and spasticity of patients suffering from incomplete SCI. Two patients were included: a tetraplegic female (S1) and a paraplegic male (S2) with incomplete chronic SCI (AIS D) respectively 30 and 45 years old. The program consisted in 20 BWSTT sessions of one hour, scheduled 5 days a week lasting 4 weeks. Two pre-tests 4 weeks apart were performed in order to establish a baseline before the BWSTT. We assessed the intervention effects with two post-tests, performed immediately after BWSTT and nine months later. Measures consisted in kinematic gait recording, six Minutes Walking Test (6MWT) and spasticity assessment using the Ashworth Modified Scale. Motor performances were stable during baseline. Immediately after BWSTT, gait speed increased respectively for S1 and S2 by 25% and 33% (from 0.61 to 0.80 ms −1 and 0.64 to 0.79 ms −1 ). Similarly, 6MWT distance increased from 198 to 337 m (S1) and 270 to 353 m (S2). Nine months after BWSTT, gait speed further improved by 21% and 5% (0,98ms −1 –S1) et 5% (0,83ms −1 –S2). Participants walked 600 m (S1) and 445 m (S2) during the 6MWT. Angular kinematic evidenced a shift toward normalization particularly altering knee and ankle joints on both patients. Spasticity remained unchanged after BWSTT. Classical rehabilitation results in walking performance stability at chronic stage. In two participants with chronic incomplete SCI, BWSTT demonstrated an additional improvement of both gait performance and quality without spasticity increase. A one-month program based on BWSTT can be proposed to walking patients with incomplete chronic SCI in order to enhance gait speed, improve motor control and efficiency of walking without spasticity enhancement.

Robotic neurorehabilitation in patients with chronic stroke: psychological well-being beyond motor improvement.

Although gait abnormality is one of the most disabling events following stroke, cognitive, and psychological impairments can be devastating. The Lokomat is a robotic that has been used widely for gait rehabilitation in several movement disorders, especially in the acute and subacute phases. The aim of this study was to evaluate the effectiveness of gait robotic rehabilitation in patients affected by chronic stroke. Psychological impact was also taken into consideration. Thirty patients (13 women and 17 men) affected by chronic stroke entered the study. All participants underwent neurological examination with respect to ambulation, Ashworth, Functional Independence Measure, and Tinetti scales to assess their physical status, and Hamilton Rating Scale for Depression, Psychological General Well-being Index, and Coping Orientation to Problem Experienced to evaluate the Lokomat-related psychological impact before and after either a conventional treatment or the robotic training. During each rehabilitation period (separated by a no-treatment period), patients underwent a total of 40 1 h training sessions (i.e. five times a week for 8 weeks). After the conventional treatment, the patients did not achieve a significant improvement in the functional status, except balance (P<0.001) and walking ability (P<0.01), as per the Tinetti scale. Indeed, after the robotic rehabilitation, significant improvements were detected in almost all the motor and psychological scales that we investigated, particularly for Psychological General Well-being Index and Coping Orientation to Problem Experienced. Manual and robotic-assisted body weight-supported treadmill training optimizes the sensory inputs relevant to step training, repeated practice, as well as neuroplasticity. Several controlled trials have shown a superior effect of Lokomat treatment in stroke patients' walking ability and velocity in particular. Therefore, our preliminary results proved that active robotic training not only facilitates gait and physical function but also the psychological status, even in patients affected by chronic stroke.

Changes of pelvis control with subacute stroke: A comparison of body-weight- support treadmill training coupled virtual reality system and over-ground training.

Gait recovery is very important to stroke survivors to regain their independence in activity of daily life. This study aimed to investigate the effects of virtual reality (VR) coupled body weight support treadmill training (BWSTT) on pelvic control at the early stage of stroke. Kinematic and kinetic changes of pelvic motion were evaluated by a 3D gait analysis system and were compared to the results from over-ground walking training. Twenty-four patients having unilateral hemiplegia with subacute stroke were recruited to a VR coupled BWSTT group (n= 12) and a conventional therapy (CT) group (n= 12). Both of the groups received training of 20-40 min/day, 5 days/week, for 3 weeks. The results showed the tilt of pelvis in sagittal plane improved significantly (P= 0.038) after treatment in the BWSTT+VR group, in terms of decreased amplitude of anterior peak (mean, from 10.99° to 6.25°), while there were no significant differences in the control group. The findings suggested that VR coupled BWSTT gait training could decrease anterior tilt of pelvis in early hemiparetic persons following a modest intervention dose, and the training may have advantages over conventional over-ground gait training and can assist the therapists in correcting abnormal gait pattern of stroke survivors.

Body weight supported treadmill training on nerve cells differentiation after stem cells transplantation in rats of spinal cord injury

Objective To investigate the effect of bone marrow stem cells (BMSCs) transplantation combined with body weight supported treadmill training on neural functional recovery of rats with spinal cord injury. Methods T11 complete spinal cord injury (SCI) was introduced into 40 Sprague-Dawley male rats using an improved simple device, imitating the Allen method. The rats were randomly divided into a stem cell transplantation group, a body weight support treadmill training group, a combined treatment group and a control group, each of 10 assigned according to a random number table. One week after the SCI operation, stem cell transplantation was performed on the rats in the stem cell transplantation group and the combined treatment group. One day before their transplantation, the third passage BMSCs were labeled with 5-ethynyl-2'-deoxyuridine (Edu). The rats in body weight support treadmill training group and combined treatment group were received body weight support treadmill training, while the other two groups were not given any training. At the 1st, 2nd, 3rd, 4th and 5th week after SCI modeling, Basso-Beattie-Bresnahan (BBB) movement function score was used to evaluate the motor function recovery of all rats. At the 5th week after SCI, immunohistochemical staining and immunofluorescence staining was applied to detect neural specific markers including the neuron specific enolase (NSE), microtubule associated protein (MAP-1β) and vimentin (VIM). The survival and differentiation of the transplanted cells, as well as the nerve fiber recovery in the lesion were also observed. Results The average BBB score of the combined treatment group was (6.60±0.97) at the 2nd week after SCI operation, significantly higher than the other 3 groups, while that of the stem cell transplantation group and the body weight support treadmill training group was (5.00±0.67) and (4.80±0.63) respectively, both higher than that of the control group but without significant differences (P>0.05). In the third week after modeling, however, the value of the stem cell transplantation group rose to (8.00±0.67), significantly higher than that of the body weight support treadmill training group (6.80±0.79). The immuohistochemical staining showed that a variable degree of neural specific markers (NSE, MAP-1β, VIM) positive cells were observed in the SCI tissues of all groups, with those in the combined treatment group significantly higher than the other 3 groups. The immunofluorescence also found significantly higher fluorescence expression of neural specific protein markers including NSE, MAP-1βand VIM in the combined treatment group than the rest group, with obvious proliferation and differentiation of nerve fibers. Conclusions Stem cell transplantation combined with partial body weight supported treadmill training can effectively promote the recovery of neural function of rats with spinal cord injury, and the effect is better than solely stem cell transplantation or the weight loss training. Key words: Spinal cord injuries; Stem cell transplantation; Bodyweight supported treadmill training

Partial Body Weight-Supported Treadmill Training in Patients With Parkinson Disease: Impact on Gait and Clinical Manifestation

ObjectiveTo evaluate the effect of conventional gait training (CGT) and partial weight-supported treadmill training (PWSTT) on gait and clinical manifestation. DesignProspective experimental research design. SettingHospital. ParticipantsPatients with idiopathic Parkinson disease (PD) (N=60; mean age, 58.15±8.7y) on stable dosage of dopaminomimetic drugs were randomly assigned into the 3 following groups (20 patients in each group): (1) nonexercising PD group, (2) CGT group, and (3) PWSTT group. InterventionsThe interventions included in the study were CGT and PWSTT. The sessions of the CGT and PWSTT groups were given in patient's self-reported best on status after regular medications. The interventions were given for 30min/d, 4d/wk, for 4 weeks (16 sessions). Main Outcome MeasuresClinical severity was measured by the Unified Parkinson Disease Rating Scale (UPDRS) and its subscores. Gait was measured by 2 minutes of treadmill walking and the 10-m walk test. Outcome measures were evaluated in their best on status at baseline and after the second and fourth weeks. ResultsFour weeks of CGT and PWSTT gait training showed significant improvements of UPDRS scores, its subscores, and gait performance measures. Moreover, the effects of PWSTT were significantly better than CGT on most measures. ConclusionsPWSTT is a promising intervention tool to improve the clinical and gait outcome measures in patients with PD.

Therapeutic exercises for proximal femoral fracture of super-aged patients: effect of walking assistance using Body Weight-Supported Treadmill Training (BWSTT)

Therapeutic exercises for proximal femoral fracture of super-aged patients: effect of walking assistance using Body Weight-Supported Treadmill Training (BWSTT)

P178 – 2253: The effect of age on the improvement in motor function in patients with cerebral palsy after undergoing robotic-assisted locomotor therapy

Objective Cerebral palsy (CP) is a neurodevelopmental disorder and its manifestations usually change during the course of development. Currently, increasing emphasis is being placed on a pro-active approach in therapy, including intensive, repetitive targeted training stimulating neuroplasticity. Robotic-assisted bodyweight-supported treadmill therapy (RATT) enabled by driven gait orthosis can improve motor functions in patients with movement disorders. The aim of the study was to assess the impact of patient's age on improvement of motor functions in patients with CP. Methods 78 patients (44 males) with bilateral spastic CP, aged 4–25 years underwent 20 therapeutic units (T.U.) of RATT using driven gait orthosis with a frequency of 3 to 5 times a week. The patients participating in the study were divided into groups according to age and severity of motor impairment determined by the Gross Motor Function Classification System (GMFCS). Outcome measures were dimension A (lying, rolling), B (sitting), C (crawling, kneeling), D (standing) and E (walking, running, jumping) of the Gross Motor Function Measure (GMFM-88). Results After completing 20 therapeutic units patients demonstrated highly statistically significant improvement (p Conclusion Our study indicates, that RATT can improve the gross motor functions. Effect of the age on improvement in this study has not been demonstrated. Thus, RATT can be suitable and promising treatment option in ambulatory and nonambulatory patients with CP of all ages.

Robotic-assisted gait training in neurological patients: who may benefit?

Regaining one's ability to walk is of great importance for neurological patients and is a major goal of all rehabilitation programs. Gait training of severely affected patients after the neurological event is technically difficult because of their motor weakness and balance disturbances. An innovative locomotor training that incorporates high repetitions of task-oriented practice by the use of body weight-supported treadmill training (BWSTT) was developed to overcome these obstacles. To facilitate the delivery of BWSTT, a motorized robotic driven gait orthosis (robotic-assisted gait training-RAGT) was developed. Two types of robotic gait devices were developed, end-effector and exoskeleton devices. Several randomized controlled trials have been published regarding the usage of RAGT in patients after stroke, spinal cord injury (SCI), multiple sclerosis (MS) and other neurological diseases. According to these trials, the usage of RAGT in combination with conventional rehabilitation treatment has some additive beneficial effect on the ambulation abilities mainly in sub-acute stroke and sub-acute SCI patients. No difference was found between the two types of robotic gait devices. No sufficient data regarding an optimal protocol of RAGT is available, however a longer duration and a higher intensity of RAGT seem to have more beneficial effect on the final functional ambulation outcomes. Larger controlled studies are still required to determine the optimal timing and protocol design for the maximal efficacy and long-term outcome of RAGT in neurological patients.

Architectural Changes of Thigh Muscles in Patients with Subacute Stroke after Body Weight Support Treadmill Training

Body weight support treadmill training (BWSTT) can improve motor function of lower limb in stroke patients, but it is not clear the underlying biomechanical contributors to these improvements. The purpose of this study was to evaluate changes of thigh muscle architecture parameters after stroke and compare the effect of BWSTT and traditional walking training at muscle fascicle level by using ultrasonography. This study showed that there are considerable changes in the thigh muscle architecture poststroke, which may contribute directly to muscle weakness and impaired motor functions in stroke survivors. BWSTT can improve the motor function of subacute stroke patients by change the muscle architecture and it is feasible and more effective than conventional gait training with regard to clinical scales. In addition, muscle ultrasound is an excellent tool for quantifying muscle changes in stroke patients. Keywords: Body-weight-supported treadmill Training (BWSTT), stroke, muscle architecture, ultrasonography.

Commentary on “Body Weight Support Treadmill Training for Children With Developmental Delay Who Are Ambulatory”

“How should I apply this information?” Weekly body weight-supported treadmill training (BWSTT) may have measurable and lasting effects on gait velocity and gross motor skills related to walking, with a relatively low investment of time (6 weeks). Increases in treadmill speed or changes in other BWSTT parameters were predicated on the quality of gait individually for each participant. Therefore, therapists may expect to implement variability and adaptability within BWSTT to maximize outcomes. Subjects were 2 to 5 years old, indicating the importance of early intervention to produce a great effect on the developing gait pattern. Body weight-supported treadmill training is often used with children acquiring or regaining the skills to ambulate. However, the study results support that the use of BWSTT improved gait in children with developmental delay who could already ambulate independently. Therefore, an expanded population of children might benefit from BWSTT. “What should I be mindful about when applying this information?” The overground walking activity performed by the children was not measured in either group and may have influenced the results. In addition, the average number of BWSTT sessions attended by the experimental group ranged from 55% to 83% of the maximum number of sessions offered. It is not clear whether children with higher attendance made more gains than children who missed more sessions. It remains unknown which dosage of treadmill training might yield optimal results, and whether the improved walking speed and gross motor skills resulted in an increase in overall physical activity and participation. Stephanie Yu, PT, MSPT, PCS California Children's Services, County of Los Angeles, El Monte, California Katrin Mattern-Baxter, PT, DPT, PCS California State University, Sacramento, Sacramento, California

虚弱高齢者における空気圧式体重免荷トレッドミルの歩行分析

［目的］虚弱高齢者に対する空気圧式体重免荷トレッドミル（以下AP-BWST）が免荷量の違いにより，1歩行周期，歩行率，歩幅に与える影響を検証することである。［対象］通所リハビリを利用している20名とした。［方法］Anti-Gravity TreadmillⓇを使用。体重免荷（BWS）は，全荷重（FWB），20％BWS，40％BWS に設定，歩行速度は2km／h とした。各歩行時の体幹加速度を計測し，最大振幅値と1歩行周期，歩行率，歩幅を算出した。［結果］FWB と20％BWS，FWB と40％BWS の比較は，1歩行周期延長，歩行率減少，歩幅拡大した（p＜0．01）。20％BWS と40％BWS の比較は，有意な変化はみられなかった。［結語］虚弱高齢者のAP-BWST は，体重を免荷した歩行（20％BWS，40％BWS）によって，歩幅が大きく歩行率が低下した歩行パターンに変化することが示唆された。

Improvement of gait ability with a short-term intensive gait rehabilitation program using body weight support treadmill training in community dwelling chronic poststroke survivors.

[Purpose] Most previous studies have shown that body weight support treadmill training (BWSTT) can improve gait speed poststroke patients. The purpose of this study was to evaluate effectiveness of a short-term intensive program using BWSTT among community dwelling poststroke survivors. [Subjects] Eighteen subjects participated in this study. The treatment group was composed of 10 subjects (2 women; 8 men; mean age, 59.1 ± 12.5 years; time since stroke onset, 35.3 ± 33.2 months), whereas the control group was made up of 8 subjects (3 women; 5 men; mean age, 59.8 ± 6.3 years; time since stroke onset, 39.3 ± 27.3 months). [Methods] The treatment group received BWSTT 3 times a week for 4 weeks (a total of 12 times), with each session lasting 20 minutes. The main outcome measures were maximum gait speed on a flat floor, cadence, and step length. [Results] No differences were observed in the baseline clinical data between the 2 groups. The gait speed in the treatment group was significantly improved compared with that in the control by 2-way ANOVA, while the other parameters showed no significant interaction. [Conclusion] These results suggested that short-term intensive gait rehabilitation using BWSTT was useful for improving gait ability among community dwelling poststroke subjects.

The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke.

Objective. Gait performance is an indicator of mobility impairment after stroke. This study evaluated changes in balance, lower extremity motor function, and spatiotemporal gait parameters after receiving body weight supported treadmill training (BWSTT) and conventional overground walking training (CT) in patients with subacute stroke using 3D motion analysis. Setting. Inpatient department of rehabilitation medicine at a university-affiliated hospital. Participants. 24 subjects with unilateral hemiplegia in the subacute stage were randomized to the BWSTT (n = 12) and CT (n = 12) groups. Parameters were compared between the two groups. Data from twelve age matched healthy subjects were recorded as reference. Interventions. Patients received gait training with BWSTT or CT for an average of 30 minutes/day, 5 days/week, for 3 weeks. Main Outcome Measures. Balance was measured by the Brunel balance assessment. Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale. Kinematic data were collected and analyzed using a gait capture system before and after the interventions. Results. Both groups improved on balance and lower extremity motor function measures (P < 0.05), with no significant difference between the two groups after intervention. However, kinematic data were significantly improved (P < 0.05) after BWSTT but not after CT. Maximum hip extension and flexion angles were significantly improved (P < 0.05) for the BWSTT group during the stance and swing phases compared to baseline. Conclusion. In subacute patients with stroke, BWSTT can lead to improved gait quality when compared with conventional gait training. Both methods can improve balance and motor function.