Partial Body Weight-supported Treadmill Research Articles

The effectiveness of partial body weight support treadmill training on walking in people with cerebral palsy

Background: People with Cerebral Palsy (CP) face daily motor, sensory, and cognitive impairments that significantly impact their quality of life. This systematic review aimed to investigate RCTs regarding the effectiveness of treadmill walking with partial body weight support (PBWSTT) in individuals with CP. Methods: A search was performed in PubMed, Scopus and Research Gate. The study selection process was conducted by two separate reviewers. The quality of the final studies included in the systematic review was assessed using the PEDro scale. Results: Out of the 673 studies initially identified, 6 studies were included. The results showed that (PBWSTT) leads to an increase in scores on the GMFM scale, as well as improvement in walking pattern, speed, endurance, and rhythm. The method of PBWSTT in comparison to conventional physiοtherapy did not show better results, as the included studies in this review showed conflicting results. Conclusion: The effect of therapeutic exercise with partial body weight support has a positive impact on improving the gross motor function of patients with Cerebral Palsy. However, the question of whether PBWSTT is more effective than conventional physiotherapy and over-ground walking exercise cannot be conclusively answered yet, highlighting the importance of conducting further research in this field.

Effectiveness of Partial Body Weight-Supported Treadmill Training on Various Outcomes in Different Contexts among Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis.

The efficiency of partial body weight-supported treadmill training (PBWSTT) for treating various conditions in children and adolescents with cerebral palsy (CP) in diverse contexts of rehabilitation, households, or schools is unknown. The major objective of this systematic review and meta-analysis was to analyze the effectiveness of PBWSTT on various outcomes in different contexts among children and adolescents with CP. We incorporated full-text, randomized controlled trial studies that specifically assessed the effects of PBWSTT walking, motor function, stride, balance, and endurance in children and adolescents aged 3 to 18 years with CP. The literature search was carried out using Google Scholar, PubMed, Web of Science, CINAHL Plus, Scopus, PEDro, and ResearchGate databases. The methodological quality was evaluated using a Cochrane risk of bias instrument. A meta-analysis of pooled data from 10 studies with 255 participants demonstrated that PBWSTT for 4-12 weeks in rehabilitation (mean difference [MD] = 1.94, 95% confidence interval [CI] = 1.40-2.48, p < 0.0001), at home or in a school context (MD = 13.5, 95% CI = 13.9-16.0, p < 0.0001), was significantly effective for treating various conditions in children and adolescents suffering with CP. The period of 4-12 weeks of PBWSTT in rehabilitation and at-home/school settings is effective on various outcomes in children or adolescents with CP.

ACTIVE STRIDES-CP: protocol for a randomised trial of intensive rehabilitation (combined intensive gait and cycling training) for children with moderate-to-severe bilateral cerebral palsy

IntroductionFor children with cerebral palsy (CP), who are marginally ambulant, gross motor capacity peaks between 6 and 7 years of age with a subsequent clinical decline, impacting their ability to...

Study protocol of a randomised controlled trial for the effectiveness of a functional partial body weight support treadmill training (FPBWSTT) on motor and functional skills of children with ataxia

IntroductionA great heterogeneity characterises the paediatric population with ataxia, which has been studied poorly. The lack of postural control and coordination, in addition with features of the ‘ataxic’ gait are...

Comparison of the effectiveness of partial body weight-supported treadmill exercises, robotic-assisted treadmill exercises, and anti-gravity treadmill exercises in spastic cerebral palsy.

This study aims to compare the effectiveness of the partial body weight-supported treadmill exercise (PBWSTE), robotic-assisted treadmill exercise (RATE), and anti-gravity treadmill exercise (ATE) in children with spastic cerebral palsy (CP). Between December 01, 2015 and May 01, 2016, a total of 29 children (18 males, 11 females; mean age 9.3±2.3 years; range, 6 to 14 years) with spastic CP were included in the study. The patients were randomly divided into three groups as the PBWSTE group (n=10), RATE group (n=10), and ATE group (n=9). Each group underwent a total of 20 treadmill exercise sessions for 45 min for five days a week for a total of four weeks. The patients were assessed using three-dimensional gait analysis, open-circle indirect calorimeter, six-minute walking test, and Gross Motor Functional Measurement (GMFM) scale before and after treatment and at two months of follow-up. No significant change compared to baseline was found in the walking speed on gait analysis among the groups after the treatment. There was no statistically significant difference among the groups in terms of the GFMF-D, GMFM-E and six-minute walking test (p>0.05). There was a significant improvement in the oxygen consumption in the ATE group (p>0.05) and RATE group (p>0.05), but not in the PBWSTE group (p<0.05). Our study findings indicate that all three treadmill exercises have a positive impact on walking, and RATE and ATE can be used more actively in patients with spastic CP.

A narrative review of gait training after stroke and a proposal for developing a novel gait training device that provides minimal assistance

Background: Gait impairment is common in stroke survivors. Recovery of walking ability is one of the most pressing objectives in stroke rehabilitation.Objectives: Of this report are to briefly review recent progress in gait training after stroke including the use of partial body weight-supported treadmill training (PBWSTT) and robot-assisted step training (RAST), and propose a minimal assistance strategy that may overcome some of limitations of current RAST.Methods: The literature review emphasizes a dilemma that recent randomized clinical trials did not support the use of RAST. The unsatisfactory results of current RAST clinical trials may be partially due to a lack of careful analysis of movement deficiencies and their relevance to gait training task specificity after stroke. Normal movement pattern is implied to be part of task specificity in the current RAST. Limitations of such task specificity are analyzed.Results: Based on the review, we redefine an alternative set of gait training task specificity that represents a minimal assistance strategy in terms of assisted body movements and amount of assistance. Specifically, assistances are applied only to hip flexion and ankle dorsiflexion of the affected lower limb during swing phase. Furthermore, we propose a conceptual design of a novel device that may overcome limitations of current RAST in gait training after stroke. The novel device uses a pulling cable, either manually operated by a therapist or automated by a servomotor, to provide assistive forces to help hip flexion and ankle dorsiflexion of the affected lower limb during gait training.Conclusion: The proposed minimal assistance strategy may help to design better devices for gait or other motor training.

Partial Body Weight-Supported Treadmill Training in Spinocerebellar Ataxia.

Background and Purpose The motor impairments related to gait and balance have a huge impact on the life of individuals with spinocerebellar ataxia (SCA). Here, the aim was to assess the possibility of retraining gait, improving cardiopulmonary capacity, and challenging balance during gait in SCA using a partial body weight support (BWS) and a treadmill. Also, the effects of this training over functionality and quality of life were investigated. Methods Eight SCA patients were engaged in the first stage of the study that focused on gait training and cardiovascular conditioning. From those, five took part in a second stage of the study centered on dynamic balance training during gait. The first and second stages lasted 8 and 10 weeks, respectively, both comprising sessions of 50 min (2 times per week). Results The results showed that gait training using partial BWS significantly increased gait performance, treadmill inclination, duration of exercise, and cardiopulmonary capacity in individuals with SCA. After the second stage, balance improvements were also found. Conclusion Combining gait training and challenging tasks to the postural control system in SCA individuals is viable, well tolerated by patients with SCA, and resulted in changes in capacity for walking and balance.

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.

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.

Attempt toward a development of aquatic exercise device for gait disorders

Purpose: To develop an aquatic exercise device to facilitate locomotive motor output and achieve repetitive physiological gait patterns to improve movement dysfunctions. Methods: A custom designed leg movement apparatus (LMA) consisted of closed 4-linkage mechanisms and one-length changeable link using a spring. Three-dimensional motions and electromyographic (EMG) activities were recorded in eight healthy subjects to evaluate the reproducibility of the physiological gait patterns using the LMA with or without a spring apparatus in water. Results: Using the LMA with a spring apparatus compared to walking in water, the foot trajectories and the time course of the elevation angles in each lower limb joint kinematics were preserved. The time-series of the EMG showed reciprocal modulation between agonist and antagonist muscle groups in the hip and ankle joints. However, the amplitudes of the tibialis anterior muscle in the first half and rectus femoris in the last half of the movement cycle were reduced using the LMA with a spring apparatus. Conclusion: We developed a novel aquatic exercise device to reproduce physiological gait patterns. The LMA with a spring apparatus would be particularly valuable in therapy for movement dysfunctions to facilitate locomotive motor outputs.Implications for RehabilitationThe leg movement apparatus with spring for underwater use (LMA) would be effective gait training to induce the locomotor-like EMG activities.Hydrotherapy with the LMA has advantages over the partial body weight support treadmill training on land with a robotic device; (1) the LMA is electrically and mechanically safe, and (2) the LMA would require self-effort to generate the gait pattern for movement disorders, or also enable passive gait training by the physiotherapists.

Influence of 3-month therapy using the neuro-orthopaedic suit Atlant on gait characteristics in preschool children with spastic cerebral palsy

Different kinds of physical therapy are used in medical rehabilitation of neurological patients with motor deficiency: partial body weight-supported treadmill training, driven gait orthosis, neuromuscular electrical stimulation and neuro-orthopaedic suit therapies. Neuro-orthopaedic pneumosuit (NOPS) Atlant (Dynaforce, Russia) creates a muscle framework by dynamic proprioceptive stimulation, stabilizing the trunk and the extremities, reducing pathological synergies and normalizing patient’s motor activity. The aim of the present study was to investigate the influence of 3-month therapy using the NOPS Atlant on gait characteristics in preschool children with spastic form of cerebral palsy (CP). Six CP children with spasticity of lower extremities with (mean±SE) age of 5.2±0.8 years participated in the present study. Children had NOPS Atlant therapy sessions during three months, supervised by an experienced physiotherapist. The kinematic and kinetic characteristics of gait were measured using 3-D movement analysis system Elite Clinic (BTS S.p.A., Italy). After 3-month therapy using the NOPS Atlant, significant increase (7.9%) of the stride length of gait was found as compared with the initial data. Children with spastic CP demonstrated significant improvement of range of motion of hip joint abduction, decrease of knee joint external rotation, as well as positive changes in foot progression angle during gait. In conclusion, motor function re-activation during gait in preschool children with spasticity caused by cerebral palsy was noted after 3-month therapy using the NOPS Atlant. However, future research is needed to elucidate mechanisms of neurodynamic therapy effect on motor ability in children with CP.

Treadmill training with partial body weight support compared with conventional gait training for low-functioning children and adolescents with nonspastic cerebral palsy

Partial body weight-supported treadmill training has been shown to be effective in gait training for patients with neurological disorders such as spinal cord injuries and stroke. Recent applications on children with cerebral palsy were reported, mostly on spastic cerebral palsy with single subject design. There is lack of evidence on the effectiveness of such training for nonspastic cerebral palsy, particularly those who are low functioning with limited intellectual capacity. This study evaluated the effectiveness of partial body weight-supported treadmill training for improving gross motor skills among these clients. A two-period randomized crossover design with repeated measures. A crossover design following an A-B versus a B-A pattern was adopted. The two training periods consisted of 12-week partial body weight-supported treadmill training (Training A) and 12-week conventional gait training (Training B) with a 10-week washout in between. Ten school-age participants with nonspastic cerebral palsy and severe mental retardation were recruited. The Gross Motor Function Measure-66 was administered immediately before and after each training period. Significant improvements in dimensions D and E of the Gross Motor Function Measure-66 and the Gross Motor Ability Estimator were obtained. Our findings revealed that the partial body weight-supported treadmill training was effective in improving gross motor skills for low-functioning children and adolescents with nonspastic cerebral palsy. .

Patterns of muscle coordination vary with stride frequency during weight assisted treadmill walking

Partial body weight-supported treadmill training is an approach for gait rehabilitation. Variables such as stepping frequency and the amount of body weight support are key parameters manipulated during training. The purpose of this study was to quantify the extent to which body weight support and stride frequency contribute and interact to produce the coordination patterns of the leg muscles. Principal components analysis was used to provide insight into the interaction effects of these factors on electromyographical (EMG) activity during treadmill locomotion. Eight healthy subjects walked on a treadmill at 15 different combinations of weight support (0%, 20%, 40%, 60%, 100%), and stride frequency (0.40, 0.49, 0.57 Hz). Treadmill walking was performed with the Lokomat robotic gait orthosis to constrain leg kinematics. Surface EMG data were collected from several lower limb muscles. Results indicate that much of the variance in EMG activity during treadmill locomotion can be attributed to the mechanics of the locomotor task imposed by the level of body weight support and stride frequency. We also showed that body weight support and stride frequency interact in different ways to affect muscle coordination patterns. EMG coordination patterns are similar between conditions of high levels of body weight support and faster stride frequencies vs. lower levels of body weight support and slower stride frequency. Our data suggest that the interaction of body weight support and stride frequency should be taken into consideration for optimizing motor output during locomotor training.

Effects of Partial Body Weight Support while Training Acute Stroke Patients to Walk Backwards on a Treadmill -A Controlled Clinical Trial Using Randomized Allocation-

[Purpose] We tested the efficacy of an intervention training acute stroke patients to walk backwards on a treadmill. Subjects were randomly allocated to three groups of Partial Body Weight Support treadmill backward walking group, Partial Body Weight Support treadmill forward walking group and Control in order to compare the efficacy of the interventions among the groups. [Subjects] The subjects were 36 acute stroke patients. [Methods] They were randomly allocated to the three groups using an envelope method. After 3 weeks of intervention. We investigated by multiple comparisons among the three groups using change scores for each of the outcome measures. [Results] The Berg Balance Scale showed no significant differences. The Rivermead Mobility Index showed a significant difference between the backward walking group and the forward walking group, and between the backward walking group and the Control. Walking speed was significantly different between the backward walking group and the Control. No differences were seen for other itemes. [Conclusions] As a result of 3-week intervention, a significant improvement was observed in walking speed and the Rivermead Mobility Index, suggesting that Partial Body Weight Support treadmill backward walking training for patients in the early phase of acute stroke is effective at improving mobility.

A guide to physiotherapy in cerebral palsy

This review aims to elucidate current thinking and physiotherapy practice in the treatment and management of children with cerebral palsy (CP). It discusses established approaches to treatment, such as Bobath/NDT, conductive education and sensory integration, commonly used by therapist to address the problems seen in children with CP. The review also explores interventions that are currently advocated for the treatment of specific groups of people with CP, including constraint induced movement therapy, partial body weight-supported treadmill training and strength-training programmes.

The effects of partial body weight support treadmill training in stroke with hemiplegia: a randomized trial

目的 比较减重步行训练结合常规康复治疗与常规康复治疗对脑卒中后偏瘫患者的临床疗效.方法 98例脑卒中后偏瘫患者,随机分为2组:减重步行训练结合常规康复治疗组(减重步行训练组,48例);常规康复治疗组(50例).脑卒中后偏瘫患者入选后分别在治疗前,治疗后的1、2个月进行以下评定:1、下肢运动功能评定(Fugl-Meyer量表);2、功能性步行量表(Functional Ambulation Category,FAC);3,日常生活行为Barthel指数量表(Activity of Daily Life,ADL),2组患者入组后开始为期2个月的康复治疗.结果 两组患者的Fugl-Meyer、FAC、Barthel指数评分治疗前差异无统计学意义(P＞0.05),治疗后1、2个月组内差异均有统计学意义(P＜0.05).结论 减重步行训练结合常规康复治疗能更好地提高脑卒中后偏瘫患者的运动能力。

Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract

We investigated the association between the degree of lesion overlap with the corticospinal tract and walking performance before and after 4-weeks of partial body weight support (PBWS) treadmill training in 18 individuals (ten male, eight female) with a mean age 59 +/- 13 years (mean +/- SD), range 32-74 years, who were ambulant and 6 months from a subcortical ischaemic stroke. Lesion volumes were manually defined on high resolution T1-weighted 3T-MRI scans and a probabilistic map of the corticospinal tract created using diffusion tensor imaging data collected previously in healthy subjects. The percentage overlap between the lesion and the corticospinal tract was calculated for each patient. Walking performance was determined by measures of 10 m speed, spatiotemporal parameters, percentage recovery of centre of mass (CoM), walking symmetry and 2-min endurance walk prior to and following 4 weeks of treadmill training with PBWS that emphasised normal fast walking. Lesion overlap measures weakly correlated with walking performance measures. Spatiotemporal and performance measures changed in response to training, but spatial symmetry and mechanical energy recovery did not. Walking speed at entry to the study predicted change in response to training of 10 m walk time and swing time asymmetry. Age and lesion overlap did not add to prediction of outcome models. The extent of lesion overlap with the corticospinal tract was not strongly associated with either walking performance or response to gait retraining, despite the correlation of these parameters with upper limb recovery.

Effects of Stroke Severity and Training Duration on Locomotor Recovery After Stroke: A Pilot Study

Background. Locomotor training using partial body weight-supported treadmill (BWST) walking has been widely investigated for people after stroke, yet there remains a lack of evidence concerning the optimal training duration and the effect of locomotor impairment severity. Previous protocols have not emphasized the transfer of locomotor skills from the BWST environment to overground. Objectives. To assess the feasibility of a program combining locomotor training using BWST with task-specific overground training and to obtain pilot data on the effects of severity and training duration on recovery of locomotion. Methods. Seven adults with chronic poststroke hemiparesis and gait speed less than 0.8 m/s were recruited to participate in a 12-week (36 session) locomotor training program. Each session comprised 20 to 30 minutes of training using BWST with manual assistance, followed by 10 to 15 minutes of overground training to transfer the skills trained in the BWST environment. Gait speed was the primary outcome measure. Results. Six out of the 7 enrolled individuals completed the intervention program; 1 was withdrawn due to transportation difficulties affecting compliance with the training schedule. Four of the 6 participants had a functionally significant improvement in walking speed after 36 sessions, defined as having achieved a 0.4 m/s gait speed or greater for those with initial severe gait speed impairment (<0.4 m/s) or as having achieved a 0.8 m/s gait speed or greater for persons with initial moderate gait speed impairment (≥0.4 m/s and <0.8 m/s). All participants improved in balance and distance walked over 6 minutes, and 5 of the 6 participants showed increases in their daily home and community step activity. Conclusions. A locomotor training program combining walking using BWST and manual assistance with overground practice is feasible for people with chronic poststroke hemiparesis and moderate or severe gait speed impairment. This intervention shows promise for achieving functionally significant improvements in walking speed.

PARTIAL BODY WEIGHT SUPPORT TREADMILL TRAINING IMPROVES BALANCE AND GAIT IN A FRAIL OLDER ADULT.

Purpose/Hypothesis: Partial body weight support treadmill training (PBWSTT) has been documented to improve balance, walking ability, gait speed, and gait symmetry in people who have experienced a stroke, spinal cord injury, or traumatic brain injury. Given these improvements and the task specific nature of PBWSTT, one question is whether this intervention could have a similar effect in frail older adults at a high risk for falls. By supporting part of the person's body weight, the postural demands of walking are decreased, improving the ability to walk with a normal gait pattern at a desired faster speed. Also, by supporting some of the body weight, the energy demands are decreased, allowing the person to walk for longer distances. This intervention may allow for improvements in gait speed and balance in frail older adults and therefore increase their mobility and decrease their risk for falls. The purpose of this study was to determine the effects of PBWSTT on the balance and gait characteristics of an older adult with a history of falls. Number of Subjects: One. Materials/Methods: A single subject ABAA design with multiple measurements was used. The subject was a 97 year-old female with a history of balance problems and falls. The Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), and the GAITRite computerized gait analysis system were utilized in data collection. The A1 phase consisted of outcome measures gathered four times per week for two weeks to establish a baseline. The B phase, the intervention phase, consisted of PBWSTT three times per week for four weeks with outcome measurements recorded two of three sessions each week. The A2 phase immediately followed the B phase and mirrored the A1 phase. The A3 phase was scheduled to be performed five months after the B phase and mirror the A1 phase. Data was analyzed using the two standard deviation band method, with two consecutive data points outside the band considered a significant change Results: Compared to the A1 phase, the subject demonstrated significant increases in BBS score, velocity, cadence, and stride length, and a significant decrease in base of support in the B and A2 phases. As a result of a change in our subject's medical status during the time between the A2 and A3 phases, data was not collected for the A3 phase. Average BBS scores for the A1, B, and A2 phases were 33.25, 40.5, and 44.8 respectively. Gait speed averaged .61 m/s in the A1 phase, .85 m/s in the B phase, and .84 m/s in the A2 phase. Conclusions: A 97-year-old female with a history of balance deficits and falls was found to tolerate and benefit from a four-week training program of partial body weight support treadmill training as demonstrated by improvements in balance and gait characteristics. These improvements were maintained throughout the two-week follow up. Clinical Relevance: Decreased balance and slower gait speed are associated with falls in older adults. PBWSTT may be an effective intervention to improve balance and gait and decrease the risk for falls.

Stroke and neurodegenerative disorders. 3. stroke: rehabilitation management

Bogey RA, Geis CC, Bryant PR, Moroz A, O’Neill BJ. Stroke and neurodegenerative disorders. 3. Stroke: rehabilitation management. 2004;85(3 Suppl 1):S15–20. This self-directed learning module highlights common rehabilitation issues in stroke survivors. Topics include spasticity, constraint-induced movement therapy, partial body weight-supported treadmill training, virtual reality training, vestibular retraining, aphasia treatment, and cognitive retraining. It is part of the study chapter on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Overall article objectives (a) To identify and review the treatment options for poststroke spasticity; (b) to review the use of body weight-supported treadmill training in stroke patients; (c) to describe virtual reality training as an adjunct in stroke rehabilitation; (d) to review vestibular rehabilitation; (e) to discuss advances in aphasia treatment; (f) to discuss cognitive retraining; and (g) to provide an update on treatment of neglect syndromes.