For me body weight supported treadmill training was worthless. I needed 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.
Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 97 (2024)
Abstract
Background
Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses.
Method
A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles.
Results
Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies.
Conclusion
Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
Background
Over the last decades, gait rehabilitation technology has seized a firm spot in the rehabilitation of individuals with neurological gait disorders, such as stroke, spinal cord injury, cerebral palsy and multiple sclerosis [1, 2]. Rehabilitation technology is widely used to assess gait quality and behavior [3], and to improve gait function through the use of supportive training devices [1]. Many of these training devices have found their way into clinical practice and have been implemented within rehabilitation centers. Amongst these rapid innovative developments, there has been great interest in body weight support (BWS) devices. These devices have emerged as an appealing option to clinicians as they stimulate early gait training and reduce the physical burden on a therapist [4].
The use of BWS devices has shown promise in improving walking ability and avoiding the development of malfunctional compensatory movement patterns in various patient groups [4,5,6]. Generally, BWS is provided by an overhead suspension mechanism and a harness that apply vertical forces on a person’s pelvis or trunk causing partial weight reduction [7]. Initially, BWS training was mainly offered to individuals with a spinal cord injury, as its working mechanism was primarily associated with neuroplasticity [8, 9] and functional re-organization of neuronal networks [10]. Then, BWS devices were also used for other diagnoses, as they reduce the load on the lower limbs [11], improve vertical alignment and trunk stability [12], enhance gait initiation [13] and improve physical fitness [14]. It is also thought that BWS reduces the fear of falling through prevention mechanisms that ensure a safe walking environment [4].
Recently, BWS devices have developed from stationary, treadmill-coupled devices to more elaborate mobile and ceiling-mounted systems with multiple degrees of freedom that can be used during overground walking [15]. The current developments in BWS devices accompany the trend towards promoting active participation in training and providing assist-as-needed based on patient-specific requirements [16]. Roughly, four main categories of BWS devices can be distinguished: frame-based constructions (either stationary or mobile) and ceiling mounted devices (either unidirectional or multidirectional). Well-known examples of frame-based constructions are the Woodway Loko system (stationary, Woodway USA Inc., USA) and the LiteGait (mobile, Mobility Research, USA), whereas examples of ceiling-mounted devices are the ZeroG (unidirectional, Aretech, USA) and the RYSEN (multidirectional, Motek Medical, The Netherlands).
Although all different types of BWS devices are frequently used in rehabilitation programs, guidance in selecting an appropriate support level is limited. In literature, providing BWS up to 30% is generally recommended as this is shown to allow walking with close to normal kinematics [17, 18]. However, gait rehabilitation depends on more factors than solely normal gait kinematics and therapists may consider different reasons to select BWS levels, such as patient-specific characteristics or training goals. Guidelines on clinically relevant and feasible BWS selection are currently lacking and therapists often subjectively determine BWS levels based on visual inspection and patient’s feedback.
This systematic review aims to describe the initial BWS levels used during gait training, the rationale for this selection, the clinical goals that are aligned with the use of BWS and whether these differ between diagnoses. Moreover, the study aims to describe whether pursued training goals are more likely to be achieved at particular BWS levels and within a particular diagnosis. Insights from this study can serve as a first step towards developing clinical guidelines.
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