Ambulation training of neurological patients on the treadmill with a new Walking Assistance and Rehabilitation Device (WARD)

Abstract

Study design: Patients with neurological walking impairment were rehabilitated with a new system, consisting of an apparatus to constantly relieve the body weight and a treadmill: The Walking Assistance and Rehabilitation Device (WARD). Patients were evaluated before and after rehabilitation with clinical scales and physiological measurements. Objectives: To evaluate the eectiveness of the WARD in improving walking capability in these patients. Setting: The study was carried out in a clinical environment (IRCCS S. Lucia, Rehabilitation Hospital, Rome, Italy). Methods: Seven patients (six with spinal cord injuries, one with brain injury) underwent a 1 ± 2 month training period with the WARD. During the WARD training the body weight constant unloading (BWCU) applied to the patient through the WARD was regularly evaluated. Oxygen consumption, carbon dioxide production and heart rate were measured in order to obtain energy and cardiac costs of walking. These measurements were carried out while walking with the WARD at an appropriate treadmill speed (ATS) and in the open ®eld at the most comfortable speed (MCS). All measurements, in addition to clinical scores related to the walking capability, were carried out at the beginning of the WARD training period (BWT) and at the end (EWT). At the EWT the patients were tested walking with the WARD observing the same BWT conditions (same ATS and BWCU), referred to as beginning conditions second measurements (BCSM). The relationships between physiological costs and ATS were described through second order polynomial regression curves and studied. Results: Comparing the data obtained at the BWT and EWT, the following results were found signi®cantly dierent: (1) Clinical scores improved; (2) All patients increased their ATS; (3) The BWCU was reduced; (4) The Walking Energy Cost (WEC) and the Walking Cardiac Cost (WCC) measured when walking with the WARD at the ATS improved in all patients; and (5) The WEC and WCC measured in the open ®eld improved in all patients. The WEC vs ATS curve found at the EWT in the BCSM was found signi®cantly dierent from the BWT curve, demonstrating a major improvement due to the WARD training. Conclusion: Despite some limitations due to sample size and functional ambulation scale, this study has demonstrated that the WARD training is eective in improving the walking capability and eciency of the patients.

Physiological costs and temporo-spatial parameters of walking on a treadmill vary with body weight unloading and speed in both healthy young and older women

“…It has also been shown that the walk ratio (WR), which is expressed as the ratio between stride length (SL) and stride frequency (SF), a speed-independent index of walking pattern (Nagasaki et al 1996), is smaller in older individuals than their young counterparts due to a greater reduction in SL rather than SF (Kerrigan et al 1998;Winter et al 1990). An invariant WR at different walking speeds often characterises a normal walking pattern (Sekiya and Nagasaki 1998) and is optimal with respect to the energy cost (Zarrugh et al 1974) It has been demonstrated that training on a treadmill with an apparatus of body weight unloading (BWU) is an effective tool in the rehabilitation of both neurological (Dietz et al 1995;Gazzani et al 1999) and orthopaedic patients (Fritz et al 1997;Mangione et al 1996) with locomotor impairment. Unloading of a given percentage of body weight allows early mobilisation of patients who are unable to support their own body weight or stand erect due to neuromuscular weakness.…”

Supported Treadmill Training for Gait and Balance in a Patient With Progressive Supranuclear Palsy

“…With a body weight support system, extraneous muscular contractions are reduced. 30 In previous studies, 16,18 EMG and kinematic recordings demonstrated that treadmill and body weight unloading reduce gait asymmetry as well as induce the acquisition of motor patterns similar to normal gait. In addition, the repetition and consistent nature of walking on a moving treadmill might help the patient to repeatedly practice the movement under controlled conditions.…”

“…27 Extraneous muscular contractions are also reduced with a body weight support system. 30 Evidence from EMG and kinematic recordings suggested that body weight unloading on the treadmill reduced gait asymmetry and induced the acquisition of a more normal gait. 16,18 The purpose of this case report is to report an 8-week rehabilitation program for a patient with PSP.…”

Comparison of neural activation and energy cost during treadmill walking with body weight unloading between frail and healthy older women

“…The use of a treadmill in conjunction with a partial body weight unloading (BWU) apparatus has been shown to be effective in the rehabilitation of gait in both neurological [11] and orthopedic patients [12]. Thomas et al [13,14] have demonstrated that healthy older women can be successfully trained by walking on a treadmill at 40% BWU, thus achieving higher speeds than they would do in normal gravity conditions without increasing their energy and cardiac cost.…”