Objective: To investigate the effect of body weight support on the gait of hemiparetic subjects walking on a treadmill. Design: Survey. Patients: Eleven nonambulatory hemiparetic subjects. Methods: Subjects walked on the treadmill with full weight bearing and with 15%, 30%, 45%, and 60% body weight support at constant walking velocity. Cycle parameters, symmetry ratios, and the kinematic EMG of several lower limb muscles of the affected leg were recorded. Video-analysis served for assessment of posture and hip and knee angle displacement. Results: With body weight support the relative double support time decreased, the relative single stance period of the affected limb increased, and the functional activity of the vastus and soleus diminished. The activity of the gluteus tended to increase. Patients walked more upright and with less hip and knee flexion. The extensor spasticity did not change and the qualitative activation pattern of all recorded muscles remained unchanged. Conclusion: Body weight support did not facilitate a less physiological gait. By reducing double support duration, body weight support resulted in a greater stimulus for balance training. The facilitation of gluteus medius is favorable with respect to training pelvic alignment. The reduction of the activity of other antigravity muscles suggests a limit of 30% BWS not be exceeded.
BACKGROUND: A task-specific repetitive approach in gait rehabilitation after CNS lesion is well accepted nowadays. To ease the therapists' and patients' physical effort, the past two decades have seen the introduction of gait machines to intensify the amount of gait practice. Two principles have emerged, an exoskeleton-and an endeffector-based approach. Both systems share the harness and the body weight support. With the end-effector-based devices, the patients' feet are positioned on two foot plates, whose movements simulate stance and swing phase. OBJECTIVE: This article provides an overview on the end-effector based machine's effectiveness regarding the restoration of gait. METHODS: For the electromechanical gait trainer GT I, a meta analysis identified nine controlled trials (RCT) in stroke subjects (n = 568) and were analyzed to detect differences between end-effector-based locomotion + physiotherapy and physiotherapy alone. RESULTS: Patients practising with the machine effected in a superior gait ability (210 out of 319 patients, 65.8% vs. 96 out of 249 patients, 38.6%, respectively, Z = 2.29, p = 0.020), due to a larger training intensity. Only single RCTs have been reported for other devices and etiologies. CONCLUSION: The introduction of end-effector based gait machines has opened a new succesful chapter in gait rehabilitation after CNS lesion.
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