Body Weight Support Treadmill Gait Training in the Subacute Recovery Phase of Incomplete Spinal Cord Injury

Nymark, J.; Deforge, Dan; Barbeau, Hugues; Badour, M; Bercovitch, Shelly; Tomas, John Paul Q.; Goudreau, Louis; Macdonald, Janice

doi:10.1177/154596839801200307

Cited by 24 publications

(30 citation statements)

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“…Over the course of training, both the %BWS and the treadmill speed were modified on an individual basis to increase the training intensity, following the accepted strategy of first unloading a portion of the BWS, then increasing the speed of the treadmill at each level of BWS. 2 The study protocol consisted of three training sessions per week until 144 sessions were completed -approximately 12 months. Participants completed 3 bouts of treadmill walking during each session, and the duration of walking during each bout was gradually increased according to participant tolerance.…”

Section: Training Interventionmentioning

confidence: 99%

“…Studies in both the acute [1][2][3][4] and chronic 3,[5][6][7] SCI population have shown that functional walking ability can be improved with BWSTT in patients with motor-incomplete (American Spinal Injury Association Classification (ASIA) C or D) paraplegia or tetraplegia. These results are certainly encouraging, but a number of issues need to be resolved before BWSTT becomes accepted as a standard form of rehabilitation after SCI.…”

Section: Introductionmentioning

confidence: 99%

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Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

et al. 2005

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Study design: Longitudinal, prospective within-subject design. Objectives: (1) To determine the effects of long-term body-weight-supported treadmill training (BWSTT) on functional walking ability and perceived quality of life in persons with chronic incomplete spinal cord injury (SCI), and (2) to investigate whether training adaptations are maintained following cessation of the BWSTT programme. Setting: Hamilton, Ontario, Canada. Methods: A group of 14 individuals with chronic (mean 7.4 years postinjury) incomplete SCI (ASIA B & C) participated in thrice-weekly sessions of BWSTT for a period of approximately 12 months (144 sessions). Functional walking ability and indices of subjective well-being were evaluated during the training programme and over an 8-month follow-up. Results: In total, 13 subjects successfully completed the 144 training sessions in the required study period (max. 15 months). Adherence to the thrice-weekly training frequency was 78.8%. All subjects improved in treadmill walking ability (54% reduction in required external bodyweight support (BWS), 180% increase in treadmill walking speed, 335% increase in distance walked/session), and six subjects improved their capacity to walk over ground. There were accompanying increases in satisfaction with life and satisfaction with physical function, both of which were significantly correlated with improvements in treadmill walking ability. All but one subject returned for follow-up assessment 8 months post-training; while there was a slight decline in treadmill walking performance, over ground walking scores remained relatively stable. The only change in subjective well-being in the follow-up was a slight decrease in satisfaction with physical function. Conclusion: Thrice-weekly BWSTT for 12 months was an effective stimulus to improve treadmill walking ability and indices of subjective well-being in persons with chronic incomplete SCI, and most of these improvements were maintained for up to 8 months following the cessation of training.Spinal Cord (2005) 43, 291-298.

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Section: Training Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

et al. 2005

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“…[8][9][10] The experimental intervention received clinical support from nonrandomized studies of patients with incomplete SCI early and late after injury. 2,3,[11][12][13] No randomized trials with blinded outcomes, however, had compared different physical therapy strategies aimed at the recovery of walking during initial inpatient and outpatient rehabilitation. Further, no prospective trials in SCI had collected measures related to functional walking, such as walking speed, distance, and the need for assistive devices.…”

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confidence: 99%

Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI

Dobkin¹,

Apple²,

Barbeau³

et al. 2006

Neurology

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Objective-To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.Methods-A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score <4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.Results-No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 ± 0.6 m/s, n = 30) and CONT (1.1 ± 0.7, n = 25) groups.Conclusions-The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.Annually, approximately 10,000 Americans have a traumatic spinal cord injury (SCI). For many patients, the most visible lingering disability is the inability to walk or a slow spastic- NIH Public Access Author ManuscriptNeurology. Author manuscript; available in PMC 2014 July 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript paretic gait with high energy cost. 1 A gait training strategy, using body weight support on a treadmill (BWSTT), 2,3 has evolved from physiologic studies of the effects of the level and timing of limb loading during stepping and of stance and swing phase kinematics in spinal transected quadrupeds [4][5][6][7] and in patients with complete SCI. [8][9][10] The experimental intervention received clinical support from nonrandomized studies of patients with incomplete SCI early and late after injury. 2,3,[11][12][13] No randomized trials with blinded outcomes, however, had compared different physical therapy strategies aimed at the recovery of walking during initial inpatient and outpatient rehabilitation. Further, no prospective trials in SCI had collected measures related to functional walking, such as walking speed, distance, and the need for assistive devices. 14,15The Spinal Cord Injury Locomotor Trial (SCILT) was a single-bli...

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“…One can measure EMG as the performance level of the SCI person improves. 4 This means that one measures EMG activity at higher walking speeds and lower BWS as training progresses. The disadvantage of this method is that one cannot clearly distinguish between the influence of the training effect and the changing walking speed 5 and BWS 6,7 on the EMG muscle activity.…”

Section: Introductionmentioning

confidence: 99%

Locomotor training with body weight support in SCI: EMG improvement is more optimally expressed at a low testing speed

et al. 2014

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Study design: Case series. Objectives: To determine the optimal testing speed at which the recovery of the EMG (electromyographic) activity should be assessed during and after body weight supported (BWS) locomotor training. Setting: Tertiary hospital, Sint Maartenskliniek, Nijmegen, The Netherlands. Methods: Four participants with incomplete chronic SCI were included for BWS locomotor training; one AIS-C and three AIS-D (according to the ASIA (American Spinal Injury Association) Impairment Scale or AIS). All were at least 5 years after injury. The SCI participants were trained three times a week for a period of 6 weeks. They improved their locomotor function in terms of higher walking speed, less BWS and less assistance needed. To investigate which treadmill speed for EMG assessment reflects the functional improvement most adequately, all participants were assessed weekly using the same two speeds (0.5 and 1.5 km h − 1 , referred to as low and high speed, respectively) for 6 weeks. The change in root mean square EMG (RMS EMG) was assessed in four leg muscles; biceps femoris, rectus femoris, gastrocnemius medialis and tibialis anterior. Results: The changes in RMS EMG occurred at similar phases of the step cycle for both walking conditions, but these changes were larger when the treadmill was set at a low speed (0.5 km h − 1 ). Conclusion: Improvement in gait is feasible with BWS treadmill training even long after injury. The EMG changes after treadmill training are more optimally expressed using a low rather than a high testing treadmill speed. Initial BWS systems were based on counterweights, 2 while recent versions incorporate dynamic BWS, which accommodates the vertical displacement of the center of mass during gait. 3 Both types have been successful in the gait rehabilitation of patients with SCI. 2,3 Even though functional tests (such as walking speed) are able to demonstrate changes in behavior, they do not directly reflect the motor output of the locomotor circuitry. Therefore, electromyography (EMG) is more recently used to document the progress made during training to better understand the underlying mechanisms of improvement. There are different ways to measure EMG changes during training. One can measure EMG as the performance level of the SCI person improves. 4 This means that one measures EMG activity at higher walking speeds and lower BWS as training progresses. The disadvantage of this method is that one cannot clearly distinguish between the influence of the training effect and the changing walking speed 5 and BWS 6,7 on the EMG muscle activity. The other strategy

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Body Weight Support Treadmill Gait Training in the Subacute Recovery Phase of Incomplete Spinal Cord Injury

Cited by 24 publications

References 0 publications

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: effects on functional walking ability and measures of subjective well-being

Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI

Locomotor training with body weight support in SCI: EMG improvement is more optimally expressed at a low testing speed

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