Simulating space walking: a systematic review on anti-gravity technology in neurorehabilitation

 

For me ut would be worthless. I need the weight of my body to counteract the spasticity of my legs. And since spasticity never goes away, even now as I'm chronic this would do no good. Overground training is much better in my opinion since it normally gives you perturbations you need to deal with, giving you better balance and preventing falls. 

And of course my doctor and therapists DID NOTHING to cure my leg spasticity.

Simulating space walking: a systematic review on anti-gravity technology in neurorehabilitation

• Bonanno M,
• Maggio MG,
• Quartarone A,
• De Nunzio AM &
• Calabrò RS 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 159 (2024) Cite this article

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Abstract

Neurological disorders, such as Parkinson’s disease (PD), multiple sclerosis (MS), cerebral palsy (CP) and stroke are well-known causes of gait and balance alterations. Innovative devices (i.e., robotics) are often used to promote motor recovery. As an alternative, anti-gravity treadmills, which were developed by NASA, allow early mobilization, walking with less effort to reduce gait energy costs and fatigue. A systematic search, according to PRISMA guidelines, was conducted for all peer-reviewed articles published from January 2010 through September 2023, using the following databases: PubMed, Scopus, PEDro and IEEE Xplore. After an accurate screening, we selected only 16 articles (e.g., 5 RCTs, 2 clinical trials, 7 pilot studies, 1 prospective study and 1 exploratory study). The evidence collected in this systematic review reported promising results in the field of anti-gravity technology for neurological patients, in terms of improvement in gait and balance outcomes. However, we are not able to provide any clinical recommendation about the dose and parameters of anti-gravity treadmill training, because of the lack of robust high-quality RCT studies and large samples.

Registration number CRD42023459665.

Introduction

Neurological disorders, such as Parkinson’s disease (PD), multiple sclerosis (MS), cerebral palsy (CP) and stroke are well-known causes of gait and balance alterations [1]. Reduced mobility owing to neurological disorders is associated with multiple consequences on cardio-vascular and muscle-skeletal systems, limiting activities of daily living and patients’ quality of life. In this context, innovative devices (i.e., robotics) are exploited in the neurorehabilitation field [2, 3]. In fact, robotic devices (such as exoskeletons and end-effectors) facilitate walking functions, even in patients with severe motor deficits due to brain damage [4]. However, these systems can limit joints movement due to the constraint of the robotic orthosis and may not allow normal gait patterns. As an alternative, NASA researchers have developed a new technology that mimics antigravity and uses differential air pressure to train astronauts to counteract muscle and bone loss. This technology consists of anti-gravity treadmills (A-GT), in which the lower half of the subject is surrounded by an air-tight, enclosed inflatable bag [5]. When the air compressor reaches the pressure in the chamber above atmospheric pressure, it creates an axial buoyant force, allowing gait training. Specifically, the air is released after the subject’s weight calibration and the calibrated weight is used as a reference for selected unweighting during exercise [5]. In addition, the anti-gravity treadmills can be used by participants of all heights, thanks to vertical frame height adjustment. The body weight support system can sustain 80% of a person’s body weight and can be adjusted progressively [6]. The safety and feasibility of A-GT was already investigated in healthy subjects, as well as in orthopaedics, post-surgical patients, and in neurological disorders [5, 7, 8]. The potential benefits of using A-GT in a neurorehabilitation context include early mobilization, walking with less effort to reduce gait energy costs and fatigue, decreasing the harmful impact on injured joints and maintain cardiorespiratory fitness [8]. One of the most used A-GTs in neurorehabilitation is the Alter G (AlterG Sports, AlterG Inc., California, USA). This helps to maintain normal muscle activation and gait patterns [9]. Thus, the use of A-GT could be an adjunctive rehabilitation treatment in those neurological patients who may manifest moderate motor deficits, allowing long-lasting aerobic training to promote neuroplastic processes. It is noteworthy that the use of A-GT could particularly involve vestibular pathways, reinforcing sensory and proprioceptive feedback, thus activating cortical areas (e.g., primary somatosensory cortex, motor cortex, insula, parietal and occipital lobes and frontal areas) [10]. In addition, aerobic exercise is a well-known way to improve neuroplasticity, as it promotes the release of neurotrophic factors like brain-derived neurotrophic factor (BDNF) [11]. However, it is still unclear whether A-GT could be beneficial and/or effective as an adjunctive innovative treatment in neurological patients. The main objective of this systematic review is to investigate the literature about the effects and potential benefits of A-GT training in neurological disorders, including PD, SM, CP, and stroke. These conditions collectively represent a significant proportion of neurological disorders worldwide and are associated with substantial gait impairment that is not easy to manage with conventional physiotherapy alone.

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