Body Weight Support Combined With Treadmill in the Rehabilitation of Parkinsonian Gait: A Review of Literature and New Data From a Controlled Study

Abstract

Background: Gait disorders represent disabling symptoms in Parkinson's Disease (PD). The effectiveness of rehabilitation treatment with Body Weight Support Treadmill Training (BWSTT) has been demonstrated in patients with stroke and spinal cord injuries, but limited data is available in PD.Aims: The aim of the study is to investigate the efficacy of BWSTT in the rehabilitation of gait in PD patients.Methods: Thirty-six PD inpatients were enrolled and performed rehabilitation treatment for 4-weeks, with daily sessions. Subjects were randomly divided into two groups: both groups underwent daily 40-min sessions of traditional physiokinesitherapy followed by 20-min sessions of overground gait training (Control group) or BWSTT (BWSTT group). The efficacy of BWSTT was evaluated with clinical scales and Computerized Gait Analysis (CGA). Patients were tested at baseline (T0) and at the end of the 4-weeks rehabilitation period (T1).Results: Both BWSTT and Control groups experienced a significant improvement in clinical scales as FIM and UPDRS and in gait parameters for both interventions. Even if we failed to detect any statistically significant differences between groups in the different clinical and gait parameters, the intragroup analysis captured a specific pattern of qualitative improvement associated to cadence and stride duration for the BWSTT group and to the swing/stance ratio for the Control group. Four patients with chronic pain or anxious symptoms did not tolerate BWSTT.Conclusions: BWSTT and traditional rehabilitation treatment are both effective in improving clinical motor functions and kinematic gait parameters. BWSTT may represent an option in PD patients with specific symptoms that limit traditional overground gait training, e.g., severe postural instability, balance disorder, orthostatic hypotension. BWSTT is generally well-tolerated, though caution is needed in subjects with chronic pain or with anxious symptoms.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03815409

Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial

“…On the other hand, a recent study did not prove a superior effect of BWSTT over conventional TT and showed that they both improved gait, balance, and disability in PD [24]. That study suggested that BWSTT might be preferred in advanced PD patients with severe postural instability, impaired balance, or orthostatic hypotension that would limit conventional TT.…”

“…In the literature, 20% is the most widely used percentage of unweighing in BWSTT studies, as individuals with PD reported that 20% body weight support was the most comfortable among 0%, 10%, 20%, and 30% unweighted supports [23]. Researchers used either 20% [7,8] or a combination of 20% and 10% [22][23][24] unweighing in their BWSTT protocols and compared BWSTT to overground gait training [7,8,24] or traditional rehabilitation programs [22,23]. None of these studies performed blinding of the participants.…”

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

“…Thus, it may stimulate increased cadence and shorter strides [53,54]. Nevertheless, analyzing the gait characteristics in healthy young adults may be meaningful because several studies have reported the positive effects of gait training programs using treadmills [18][19][20][21][22][23][24][25][26]. Second, there were limitations in the direct comparisons of GV with previous studies because most previous studies focused on elderly adults (who ranged in age from 70 to 89 years).…”

“…By contrast, walking on treadmills may be more useful for the collection of data pertaining to numerous continuous walking steps in comparison with methods involving repeated and averaged patterns due to decreased space requirements, multiple repetitions of strides, and controllability of the walking speed [17]. Recently, many studies have reported the positive effects of gait training programs using treadmills on amputees [18] and pathological patients such as people suffering from cerebral palsy [19], Parkinson's disease [20][21][22][23][24][25], and spinal cord injury [26]. However, several studies reported limitations such as lack of controls [19,24,25] and relatively small samples of patients [20,22].…”

“…Recently, many studies have reported the positive effects of gait training programs using treadmills on amputees [18] and pathological patients such as people suffering from cerebral palsy [19], Parkinson's disease [20][21][22][23][24][25], and spinal cord injury [26]. However, several studies reported limitations such as lack of controls [19,24,25] and relatively small samples of patients [20,22]. Thus, establishing normative values based on treadmill walking may be useful in a clinical environment as reference values [1,3,6].…”