Partial Body Research Articles

Use and Effects of Whole and Partial Body Bathing

Use and Effects of Whole and Partial Body Bathing

Radiation cancer risk at different dose rates: new dose-rate effectiveness factors derived from revised A-bomb radiation dosimetry data and non-tumor doses.

The dose rate of atomic bomb (A-bomb) radiation to the survivors has still remained unclear, although the dose–response data of A-bomb cancers has been taken as a standard in estimating the cancer risk of radiation and the dose and dose-rate effectiveness factor (DDREF). Since the applicability of the currently used DDREF of 2 derived from A-bomb data is limited in a narrow dose-rate range, 0.25-75 Gy/min as estimated from analysis of DS86 dosimetry data in the present study, a non-tumor dose (Dnt) was applied in an attempt to gain a more universal dose-rate effectiveness factor (DREF), where Dnt is an empirical parameter defined as the highest dose at which no statistically significant tumor increase is observed above the control level and its magnitude depends on the dose rate. The new DREF values were expressed as a function of the dose rate at four exposure categories, i.e. partial body low LET, whole body low linear energy transfer (LET), partial body high LET and whole body high LET and provided a value of 14 for environmental level radiation at a dose rate of 10−9 Gy/min for whole body low LET.

Modeling of an Innovative Nitrogen-Free Cryotherapy Device

Partial body cryotherapy cabins most often use liquid nitrogen as their cryogenic fluid, which raises safety concerns during operation. In this study, an innovative cryotherapy cabin design is presented, featuring an electric cooling system suitable for producing cold air at −30 °C. The geometry of the designed cryotherapy cabin is evaluated by a thermodynamic modeling which aims at optimizing the circulation of cold air flows inside the cabin. The numerical study is carried out in two successive phases, the first one being necessary to model the pre-cooling phase and to estimate the time required to reach an average temperature close to the set temperature of −30 °C. The second one aims at modeling a 3-min cryotherapy session by taking into account the thermal transfers between the human body and its environment. Results demonstrate the potential benefits of the cold air injection device which has been designed to optimize the thermal transfers and homogenize the temperatures within the therapeutic enclosure. The main innovation of this study is the ability to customize cryotherapy protocols by injecting cold air at different levels through targeting of specific body areas. Further calculations would be required to determine the precise impact of zone-targeted injection on skin cooling.

Constraint manipulation as a feasible strategy for gait alteration and intervention: a scoping review

In this paper, we describe general information regarding the use of the partial body weight support (BWS) paradigm as a strategy to manipulate constraints during walking by individuals with and without gait impairments. We present two overground BWS systems implemented by our research group and the main studies that have been conducted so far. Non-disabled young adults, individuals with stroke, and children with cerebral palsy were considered in our investigations. Gait assessment with different amounts of body weight unloading on both the treadmill and the ground, as well as gait training protocols with BWS on these surfaces, were conducted, and general results are reported. Based on our investigations, we suggest that the use of a BWS system on a treadmill and on the ground, as a strategy for manipulating constraints, enables individuals with gait impairment to walk. More importantly, professionals in the field of gait rehabilitation can carry out training protocols throughout the manipulation of implements that assist walking, such as using a harness connected to a structure.

Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report.

Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report.

Thermodynamic Correlation between Actual Temperature and Cryogenic Flow Rate in an Empty Cryosauna

The objective of this study was to monitor the actual temperature in an empty partial body cryotherapy cabin throughout the cooling phase that precedes the cryotherapy session. It was shown that after 9 minutes of cooling, the minimum temperature recorded inside the empty cryosauna was −66 °C while the temperature was set to −140 °C. To further investigate the relationship between the use of nitrogen as a cryogenic fluid and the actual temperature inside the cabin, we used a numerical method and modeled the convective heat transfer for 3 different flow rates (0.01, 0.03 and 0.05 kg/s). According to the simulations, a temperature of about −100 °C may be reached after 3 minutes with a flow rate of 0.05 kg/s against 5 minutes with a flow rate of 0.03 kg/s. With the lowest flow rate, it would be possible to reach −60 °C after 10 minutes. A key assumption is that a too low nitrogen flow does not provide a thermal gradient able to induce the drop in skin temperature required to achieve therapeutic effectiveness.

Experimental and computational thermal analysis of partial-body cryotherapy

During the partial body cryotherapy, human surface is cooled with gas for several minutes. For this, special heat and mass exchanger is used – a cryocabin. From a thermal engineering viewpoint, to improve this empirical treatment, detailed data are needed on the temperature and velocity of the cooling gas, as well as on the biological tissues cooling. For this, current study proposes an improved human, partial body cryotherapy simulation models and study of the partial body cryotherapy heat transfer problem in a single system “equipment-gas-biotissue” using experiment and computer simulation. For the first time the cryoexposure duration up to 420 s was analyzed. The data on the actual cooling gas temperature and velocity distributions, skin and internal biotissue temperature, bioheat flux for the considered typical gas supply mode is obtained. The impact of body mass index, external thermal resistance (body hair) and internal structure of a body parts on cooling dynamics is analyzed. This information is expected to be useful for understanding the effect-exposure correlation of the cryotherapy and in the design of the cryotherapy equipment.

Design and Simulation Analysis of a Robot-Assisted Gait Trainer with the PBWS System.

In response to the ever-increasing demand of lower limb rehabilitation, this paper presents a novel robot-assisted gait trainer (RGT) to assist the elderly and the pediatric patients with neurological impairments in the lower limb rehabilitation training (LLRT). The RGT provides three active degrees of freedom (DoF) to both legs that are used to implement the gait cycle in such a way that the natural gait is not significantly affected. The robot consists of (i) the partial body weight support (PBWS) system to assist patients in sit-to-stand transfer via the precision linear rail system and (ii) the bipedal end-effector (BE) to control the motions of lower limbs via two mechanical arms. The robot stands out for multiple modes of training and optimized functional design to improve the quality of life for those patients. To analyze the performance of the RGT, the kinematic and static models are established in this paper. After that, the reachable workspace and motion trajectory are analyzed to cover the motion requirements and implement natural gait cycle. The preliminary results demonstrate the usability of the robot.

Mass recovery following caloric restriction reverses lipolysis and proteolysis, but not gluconeogenesis, in insulin resistant OLETF rats

Caloric restriction (CR) is one of the most important behavioral interventions to reduce excessive abdominal adiposity, which is a risk factor for the development of insulin resistance. Previous metabolomics studies have characterized substrate metabolism during healthy conditions; however, the effects of CR and subsequent mass recovery on shifts in substrate metabolism during insulin resistance (IR) have not been widely investigated. To assess the effects of acute CR and the subsequent mass recovery on shifts in substrate metabolism, a cohort of 15-week old Long Evans Tokushima Otsuka (LETO) and Otsuka Long Evans Tokushima Fatty (OLETF) rats were calorie restricted (CR: 50% × 10 days) with or without partial body mass recovery (PR; 73% x 7 days), along with their respective ad libitum controls. End-of-study plasma samples were analyzed for primary carbon metabolites by gas chromatography (GC) time-of-flight (TOF) mass spectrometry (MS) data acquisition. Data analysis included PCA, Pearson correlation vs previously reported variables (adipose and body masses, and insulin resistance index, IRI), and metabolomics maps (MetaMapp) generated for the most significant group comparisons. All treatments elicited a significant group differentiation in at least one principal component. CR improved TCA cycle in OLETF, and increased lipolysis and proteolysis. These changes were reversed after PR except for gluconeogenesis. Plasma lipid concentrations were inversely correlated to IRI in LETO, but not OLETF. These shifts in substrate metabolism suggest that the CR-induced decreases in adipose may not be sufficient to more permanently alter substrate metabolism to improve IR status during metabolic syndrome.

The Natural History of Acute Radiation-induced H-ARS and Concomitant Multi-organ Injury in the Non-human Primate: The MCART Experience.

The dose response relationship and corresponding values for mid-lethal dose and slope are used to define the dose- and time-dependent parameters of the hematopoietic acute radiation syndrome. The characteristic time course of mortality, morbidity, and secondary endpoints are well defined. The concomitant comorbidities, potential mortality, and other multi-organ injuries that are similarly dose- and time-dependent are less defined. Determination of the natural history or pathophysiology associated with the lethal hematopoietic acute radiation syndrome is a significant gap in knowledge, especially when considered in the context of a nuclear weapon scenario. In this regard, the exposure is likely ill-defined, heterogenous, and nonuniform. These conditions forecast sparing of bone marrow and increased survival from the acute radiation syndrome consequent to threshold doses for the delayed effects of acute radiation exposure due to marrow sparing, medical management, and use of approved medical countermeasures. The intent herein is to provide a composite natural history of the pathophysiology concomitant with the evolution of the potentially lethal hematopoietic acute radiation syndrome derived from studies that focused on total body irradiation and partial body irradiation with bone marrow sparing. The marked differential in estimated LD50/60 from 7.5 Gy to 10.88 Gy for the total body irradiation and partial body irradiation with 5% bone marrow sparing models, respectively, provided a clear distinction between the attendant multiple organ injury and natural history of the two models that included medical management. Total body irradiation was focused on equivalent LD50/60 exposures. The 10 Gy and 11 Gy partial body with 5% bone marrow sparing exposures bracketed the LD50/60 (10.88 Gy). The incidence, progression, and duration of multiple organ injury was described for each exposure protocol within the hematopoietic acute radiation syndrome. The higher threshold doses for the partial body irradiation with bone marrow sparing protocol induced a marked degree of multiple organ injury to include lethal gastrointestinal acute radiation syndrome, prolonged crypt loss and mucosal damage, immune suppression, acute kidney injury, body weight loss, and added clinical comorbidities that defined a complex timeline of organ injury through the acute hematopoietic acute radiation syndrome. The natural history of the acute radiation syndrome presents a 60-d time segment of multi-organ sequelae that is concomitant with the latent period or time to onset of the evolving multi-organ injury of the delayed effects of acute radiation exposure.

Acute Proteomic Changes in Non-human Primate Kidney after Partial-body Radiation with Minimal Bone Marrow Sparing.

Near total body exposure to high-dose ionizing radiation results in organ-specific sequelae, including acute radiation syndromes and delayed effects of acute radiation exposure. Among these sequelae are acute kidney injury and chronic kidney injury. Reports that neither oxidative stress nor inflammation are dominant mechanisms defining radiation nephropathy inspired an unbiased, discovery-based proteomic interrogation in order to identify mechanistic pathways of injury. We quantitatively profiled the proteome of kidney from non-human primates following 12 Gy partial body irradiation with 2.5% bone marrow sparing over a time period of 3 wk. Kidney was analyzed by liquid chromatography-tandem mass spectrometry. Out of the 3,432 unique proteins that were identified, we found that 265 proteins showed significant and consistent responses across at least three time points post-irradiation, of which 230 proteins showed strong upregulation while 35 proteins showed downregulation. Bioinformatics analysis revealed significant pathway and upstream regulator perturbations post-high dose irradiation and shed light on underlying mechanisms of radiation damage. These data will be useful for a greater understanding of the molecular mechanisms of injury in well-characterized animal models of partial body irradiation with minimal bone marrow sparing. These data may be potentially useful in the future development of medical countermeasures.

Multi-omic Analysis of Non-human Primate Heart after Partial-body Radiation with Minimal Bone Marrow Sparing.

High-dose radiation exposure results in hematopoietic and gastrointestinal acute radiation syndromes followed by delayed effects of acute radiation exposure, which encompasses multiple organs, including heart, kidney, and lung. Here we sought to further characterize the natural history of radiation-induced heart injury via determination of differential protein and metabolite expression in the heart. We quantitatively profiled the proteome and metabolome of left and right ventricle from non-human primates following 12 Gy partial body irradiation with 2.5% bone marrow sparing over a time period of 3 wk. Global proteome profiling identified more than 2,200 unique proteins, with 220 and 286 in the left and right ventricles, respectively, showing significant responses across at least three time points compared to baseline levels. High-throughput targeted metabolomics analyzed a total of 229 metabolites and metabolite combinations, with 18 and 22 in the left and right ventricles, respectively, showing significant responses compared to baseline levels. Bioinformatic analysis performed on metabolomic and proteomic data revealed pathways related to inflammation, energy metabolism, and myocardial remodeling were dysregulated. Additionally, we observed dysregulation of the retinoid homeostasis pathway, including significant post-radiation decreases in retinoic acid, an active metabolite of vitamin A. Significant differences between left and right ventricles in the pathology of radiation-induced injury were identified. This multi-omic study characterizes the natural history and molecular mechanisms of radiation-induced heart injury in NHP exposed to PBI with minimal bone marrow sparing.

A Novel Method to Predict the Maximum Electric Fields in Different Body Parts Exposed to Uniform Low-Frequency Magnetic Field

Thepermissible external field strength described in international exposure guidelines and standards was derived under the assumption that humans are exposed to a uniform field in free space. However, realistic field distributions are partial body exposure to the nonuniform field. Thus, the permissible field strength has overconservative values when applying the spatial peak strength to practical compliance assessment. In this study, we discuss the relationship between the uniform external magnetic field strength and induced electric field in different body part models to help set the permissible field strength for nonuniform magnetic field exposure. We proposed a formula for estimating induced electric field from the electromotive force of cuboid models based on Faraday's law. Then, we applied the formula to homogeneous ellipsoidal and homogeneous realistically shaped models. Furthermore, we investigated the effect of model inhomogeneity to confirm the difference in the induced electric field in anatomical body models. The homogeneous ellipsoidal model was comparable to the homogeneous realistically shaped model, whereas the model inhomogeneity led to an approximately 1.5 times increase in the computed maximum electric field strength.

Rat Models of Partial-body Irradiation with Bone Marrow-sparing (Leg-out PBI) Designed for FDA Approval of Countermeasures for Mitigation of Acute and Delayed Injuries by Radiation.

The goal of this study was to develop rat models of partial body irradiation with bone-marrow sparing (leg-out PBI) to test medical countermeasures (MCM) of both acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE) under the FDA animal rule. The leg-out PBI models were developed in female and male WAG/RijCmcr rats at doses of 12.5-14.5 Gy. Rats received supportive care consisting of fluids and antibiotics. Gastrointestinal ARS (GI-ARS) was assessed by lethality to d 7 and diarrhea scoring to d 10. Differential blood counts were analyzed between d 1-42 for the natural history of hematopoietic ARS (H-ARS). Lethality and breathing intervals (BI) were measured between d 28-110 to assess delayed injury to the lung (L-DEARE). Kidney injury (K-DEARE) was evaluated by measuring elevation of blood urea nitrogen (BUN) between d 90-180. The LD50/30, including both lethality from GI-ARS and H-ARS, for female and male rats are 14.0 Gy and 13.5 Gy, respectively, while the LD50/7 for only GI-ARS are 14.3 Gy and 13.6 Gy, respectively. The all-cause mortalities, including ARS and L-DEARE, through 120 d (LD50/120) are 13.5 Gy and 12.9 Gy, respectively. Secondary end points confirmed occurrence of four distinct sequelae representing GI, hematopoietic, lung, and kidney toxicities after leg-out PBI. Adult rat models of leg-out PBI showed the acute and long-term sequelae of radiation damage that has been reported in human radiation exposure case studies. Sex-specific differences were observed in the DRR between females and males. These rat models are among the most useful for the development and approval of countermeasures for mitigation of radiation injuries under the FDA animal rule.

Metabolomics of Multiorgan Radiation Injury in Non-human Primate Model Reveals System-wide Metabolic Perturbations.

Exposure to ionizing radiation following a nuclear or radiological incident results in potential acute radiation syndromes causing sequelae of multi-organ injury in a dose- and time-dependent manner. Currently, medical countermeasures against radiation injury are limited, and no biomarkers have been approved by regulatory authorities. Identification of circulating plasma biomarkers indicative of radiation injury can be useful for early triage and injury assessment and in the development of novel therapies (medical countermeasures). Aims of this study are to (1) identify metabolites and lipids with consensus signatures that can inform on mechanism of injury in radiation-induced multi-organ injury and (2) identify plasma biomarkers in non-human primate (NHP) that correlate with tissues (kidney, liver, lung, left and right heart, jejunum) indicative of radiation injury, assessing samples collected over 3 wk post-exposure to 12 Gy partial body irradiation with 2.5% bone marrow sparing. About 180 plasma and tissue metabolites and lipids were quantified through Biocrates AbsoluteIDQ p180 kit using liquid chromatography and mass spectrometry. System-wide perturbations of specific metabolites and lipid levels and pathway alterations were identified. Citrulline, Serotonin, PC ae 38:2, PC ae 36:2, and sum of branched chain amino acids were identified as potential biomarkers of radiation injury. Pathway analysis revealed consistent changes in fatty acid oxidation and metabolism and perturbations in multiple other pathways.

Acute Proteomic Changes in Lung after Radiation: Toward Identifying Initiating Events of Delayed Effects of Acute Radiation Exposure in Non-human Primate after Partial Body Irradiation with Minimal Bone Marrow Sparing.

Radiation-induced lung injury is a delayed effect of acute radiation exposure resulting in pulmonary pneumonitis and fibrosis. Molecular mechanisms that lead to radiation-induced lung injury remain incompletely understood. Using a non-human primate model of partial body irradiation with minimal bone marrow sparing, lung was analyzed from animals irradiated with 12 Gy at timepoints every 4 d up to 21 d after irradiation and compared to non-irradiated (sham) controls. Tryptic digests of lung tissues were analyzed by liquid chromatography-tandem mass spectrometry followed by pathway analysis. Out of the 3,101 unique proteins that were identified, we found that 252 proteins showed significant and consistent responses across at least three time points post-irradiation, of which 215 proteins showed strong up-regulation while 37 proteins showed down-regulation. Canonical pathways affected by irradiation, changes in proteins that serve as upstream regulators, and proteins involved in key processes including inflammation, fibrosis, and retinoic acid signaling were identified. The proteomic profiling of lung conducted here represents an untargeted systems biology approach to identify acute molecular events in the non-human primate lung that could potentially be initiating events for radiation-induced lung injury.

Complementary Lipidomic, Proteomic, and Mass Spectrometry Imaging Approach to the Characterization of the Acute Effects of Radiation in the Non-human Primate Mesenteric Lymph Node after Partial-body Irradiation with Minimal Bone Marrow Sparing.

Radiation sequelae is complex and characterized by multiple pathologies, which occur over time and nonuniformly throughout different organs. The study of the mesenteric lymph node (MLN) due to its importance in the gastrointestinal system is of particular interest. Other studies have shown an immediate post-irradiation reduction in cellularity due to the known effects of irradiation on lymphoid cell populations, but the molecular and functional mechanisms that lead to these cellular alterations remain limited. In this work, we show the use of lipidomic, proteomic, and mass spectrometry imaging in the characterization of the effects of acute radiation exposure on the MLN at different time points after ionizing radiation (IR) from 4 d to 21 d after 12 Gy partial body irradiation with 2.5% bone marrow sparing. The combined analyses showed a dysregulation of the lipid and protein composition in the MLN after IR. Protein expression was affected in numerous pathways, including pathways regulating lipids such as LXR/RXR activation and acute phase response. Lipid distribution and abundance was also affected by IR in the MLN, including an accumulation of triacylglycerides, a decrease in polyunsaturated glycerophospholipids, and changes in polyunsaturated fatty acids. Those changes were observed as early as 4 d after IR and were more pronounced for lipids with a higher concentration in the nodules and the medulla of the MLN. These results provide molecular insight into the MLN that can inform on injury mechanism in a non-human primate model of the acute radiation syndrome of the gastrointestinal tract. Those findings may contribute to the identification of therapeutic targets and the development of new medical countermeasures.

Activity-based Rehabilitation After Incomplete Spinal Cord Injury Due To Pott's Disease: A Case Study

<h3>Research Objectives</h3> To explore the effectiveness of activity based rehabilitation (ABR), partial body weight supported treadmill training, and a comprehensive home exercise program (HEP) for return of motor function, mobility, and gait in a person with incomplete SCI due to Pott's disease (spinal tuberculosis), To assess effectiveness of ABR, treadmill training, plus performance of HEP for functional return with limited in person visits (due to pandemic and insurance restrictions), To investigate the effectiveness of ABR, partial body weight supported treadmill training, and HEP in returning to community ambulation following incomplete SCI due to Pott's disease. <h3>Design</h3> Case study, followed for 6 months. <h3>Setting</h3> Hospital based outpatient clinic. <h3>Patient</h3> A 52 year old female with incomplete T9-10 SCI due to spinal tuberculosis (Pott's disease) <h3>Interventions</h3> Patient was seen 1-2x/week x 6 months. She participated in ABR in the clinic 1-2x/week and via HEP daily, partial body weight supported treadmill training in the clinic 1x/week, overground gait and balance training in the clinic 1-2x/week, and stretching and strengthening via HEP daily. <h3>Main Outcome Measures</h3> Walking index for spinal cord injury (WISCI), 10 Meter walk, 5x sit to stand, 6 minute walk. <h3>Results</h3> Statistically significant improvements were demonstrated on all outcome measures. The patient's WISCI improved from Level 8 to level 16. Her gait speed improved from 0.2m/s to 0.58m/s with front wheeled walker (and to 0.38m/s with bilateral loftstrand crutches) per 10 Meter walk test, demonstrating a progression from a home ambulator to a limited community ambulator. Her 6 minute walk test improved from 14% to 26% of age predicted normative values. Her mobility also improved as demonstrated by a 24 second improvement in 5x sit to stand test. Overall, patient demonstrated motor return, improved mobility, and improved gait speed and distance with less restrictive assistive device after a combination of ABR, partial body weight supported treadmill training, and following a comprehensive HEP. <h3>Conclusions</h3> ABR and partial body weight supported treadmill training can be utilized as effective interventions for a patient with incomplete SCI due to Pott's disease (spinal tuberculosis). This patient had limited in person visits due to insurance restrictions, and was also given a comprehensive HEP to supplement skilled PT sessions. She demonstrated gradual improvements throughout her bout of care, supporting the use of this model with other patients with SCI due to Pott's disease. Further research is needed to determine most appropriate dosing of each intervention. <h3>Author(s) Disclosures</h3> None.

Quantification of internal dosimetry in PET patients II: Individualized Monte Carlo-based dosimetry for [18F]fluorocholine PET.

PurposeTo obtain individualized internal doses with a Monte Carlo (MC) method in patients undergoing diagnostic [18F]FCH‐PET studies and to compare such doses with the MIRD method calculations.MethodsA patient cohort of 17 males were imaged after intravenous administration of a mean [18F]FCH activity of 244.3 MBq. The resulting PET/CT images were processed in order to generate individualized input source and geometry files for dose computation with the MC tool GATE. The resulting dose estimates were studied and compared to the MIRD method with two different computational phantoms. Mass correction of the S‐factors was applied when possible. Potential sources of uncertainty were closely examined: the effect of partial body images, urinary bladder emptying, and biokinetic modeling.ResultsLarge differences in doses between our methodology and the MIRD method were found, generally in the range ±25%, and up to ±120% for some cases. The mass scaling showed improvements, especially for non‐walled and high‐uptake tissues. Simulations of the urinary bladder emptying showed negligible effects on doses to other organs, with the exception of the prostate. Dosimetry based on partial PET/CT images (excluding the legs) resulted in an overestimation of mean doses to bone, skin, and remaining tissues, and minor differences in other organs/tissues. Estimated uncertainties associated with the biokinetics of FCH introduce variations of cumulated activities in the range of ±10% in the high‐uptake organs.ConclusionsThe MC methodology allows for a higher degree of dosimetry individualization than the MIRD methodology, which in some cases leads to important differences in dose values. Dosimetry of FCH‐PET based on a single partial PET study seems viable due to the particular biokinetics of FCH, even though some correction factors may need to be applied to estimate mean skin/bone doses.

Gait alterations induced by unloaded body weight in individuals with stroke while walking on moveable and fixed surfaces

This study examined the effects of the support surface (i.e., treadmill or ground) and the quantity of body weight unloading provided by a partial body weight support (PBWS) system on the spatiotemporal gait characteristics of individuals with stroke. Fifteen individuals, aged 57.2 ± 9.8 years, with chronic stroke walked on a treadmill and on the ground with 0%, 10%, and 20% of PBWS. Inertial sensors placed on the participants’ feet registered 3-D acceleration and 3-D angular velocity during walking, and some gait parameters were calculated. Overall, individuals with stroke walked with shorter and slower strides and spent more time in contact with the support surface when walking on the treadmill compared to when walking on the ground. The duration of double limb support decreased when the percentage of PBWS increased. Stride length and speed were more variable in the paretic limb than in the non-paretic limb. Treadmill walking was more consistent and less similar to ordinary walking than walking on the ground. The gait pattern of individuals with stroke was modulated according to the support surface on which walking was performed, and the use of a PBWS system seems suitable to develop walking proficiencies on a daily basis.