A New Approach to Retrain Gait in Stroke Patients Through Body Weight Support and Treadmill Stimulation
Originally published6 Apr 2018Stroke. 2018;29:1122-1128
Abstract
Background and Purpose—A new gait training strategy for patients with stroke proposes to support a percentage of the patient’s body weight while retraining gait on a treadmill. This research project intended to compare the effects of gait training with body weight support (BWS) and with no body weight support (no-BWS) on clinical outcome measures for patients with stroke.
Methods—One hundred subjects with stroke were randomized to receive one of two treatments while walking on a treadmill: 50 subjects were trained to walk with up to 40% of their body weight supported by a BWS system with overhead harness (BWS group), and the other 50 subjects were trained to walk bearing full weight on their lower extremities (no-BWS group). Treatment outcomes were assessed on the basis of functional balance, motor recovery, overground walking speed, and overground walking endurance.
Results—After a 6-week training period, the BWS group scored significantly higher than the no-BWS group for functional balance (P=0.001), motor recovery (P=0.001), overground walking speed (P=0.029), and overground walking endurance (P=0.018). The follow-up evaluation, 3 months after training, revealed that the BWS group continued to have significantly higher scores for overground walking speed (P=0.006) and motor recovery (P=0.039).
Conclusions—Retraining gait in patients with stroke while a percentage of their body weight was supported resulted in better walking abilities than gait training while the patients were bearing their full weight. This novel gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke.
Over the past 10 years, an estimated 335 000 Canadians have suffered a stroke.1
Animal studies have shown that the adult spinal cat can recover a near-normal walking pattern after a period of interactive locomotor training in which weight support for the hindquarters is provided, hence facilitating stepping on a treadmill.8910 On the basis of these studies, we developed a gait training strategy for patients with neurological conditions that involves the use of BWS during gait training on a treadmill.1112131415 This novel approach consists of using an overhead suspension system and harness to support a percentage of the patient’s body weight as the patient walks on a treadmill and progressively decreasing the amount of body weight supported as the gait pattern improves. BWS provides symmetrical removal of weight from the lower extremities, thereby facilitating walking in patients with neurological conditions who are typically unable to cope with bearing full weight on their lower limbs. This strategy encompasses several principles that favor the recovery of locomotor abilities after a stroke. It minimizes the delay during which gait training can be initiated since patients are provided with the BWS needed to begin walking very early in the rehabilitation process. This strategy provides a dynamic and task-specific approach that integrates three essential components of gait while the patient is walking on the treadmill: weight bearing, stepping, and balance.16 The treadmill stimulates repetitive and rhythmic stepping with the patient supported in an upright position and bearing weight on the lower limbs. Gait training during actual walking favors a better recovery of walking abilities than a more conventional approach that emphasizes control of isolated components of gait before ambulation is resumed.1718 Moreover, providing BWS by symmetrically unloading both lower extremities creates an environment that discourages the development of compensatory strategies compared with gait training with walking aids, which favors an asymmetrical gait pattern.1418
Preliminary studies suggest that the use of BWS leads to a better recovery of ambulation, with effects on overground walking speed, endurance, and physical assistance required to walk.612192021 Chronic, nonambulatory patients with stroke and spinal cord injuries have been reported to regain the ability to walk after a course of gait training with BWS.15192021 Patients with stroke were also reported to have recovered better walking abilities with this approach than with the more conventional Bobath approach,22 which focuses on weight-bearing and weight-shifting activities in preparation for gait.6 These recent studies report comparisons between conventional gait training and a combination of BWS and treadmill training. Although the results suggest that BWS and treadmill training enhance locomotor recovery, the contribution of BWS in retraining gait has not been addressed. Further investigation is needed to determine whether unloading of the lower limbs, as well as progressively increasing weight bearing during training, contributes to the improvement in gait being reported.
The objective of the present study was to evaluate the effectiveness of BWS in retraining gait in patients with stroke. A randomized clinical trial was performed in which one group of stroke patients received gait training on the treadmill with BWS and one group received training on the treadmill with no BWS (under full weight-bearing conditions). Clinical outcome measures on balance, motor recovery, overground walking speed, and endurance were compared after 6 weeks of training and at a 3-month follow-up. The hypothesis was that subjects trained to walk with BWS would show greater improvements in gait than those trained to walk without BWS at the end of a 6-week training period and at a 3-month follow-up.
No comments:
Post a Comment