Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support

Hesse, Stefan; Bertelt, Christine; Schaffrin, Antje; Malezic, M; Mauritz, Karl Heinz

doi:10.1016/0003-9993(94)90083-3

Cited by 298 publications

(162 citation statements)

References 12 publications

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“…Our results are similar to those of other authors, 5,7 who have demonstrated that the treatment with treadmill and body weight support was eective in the re-acquisition of walking ability in incomplete spinal cord lesion patients. These 5,7 and other studies 6,12,18 on patients either with complete and incomplete paraplegia or hemiplegia have demonstrated that below lesion spinal cord centres can`learn' to use lower limb aerents to generate a locomotor pattern, and that the treadmill WEC (J -kg -1 -m -1 ) Figure 4 The ®lled circles are related to the relationship between the walking energy cost (WEC) and the walking cardiac cost (WCC) at the BWT. The unbroken lines represent the ®rst order polynomial regression and the 95% con®dence interval curves obtained ®tting the data at the BWT.…”

Section: Discussionmentioning

confidence: 87%

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

et al. 1999

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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.

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Section: Discussionmentioning

confidence: 87%

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

et al. 1999

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“…66 BWSTT may have a greater effect in patients with more chronic hemiparesis who walk with a poor gait pattern and slowly (less than 80 cm/s) beyond the time usually allotted for inpatient and outpatient rehabilitation. 51,61,67 Important features of training include practice at treadmill speeds consistently faster than the subject can walk over ground and physical and verbal cues from therapists who help to optimise the symmetry of stepping, joint angles, and timing of loading and unloading each leg by manipulating the legs and pelvis. No randomised clinical trial has been done.…”

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confidence: 99%

Strategies for stroke rehabilitation

Dobkin

2004

The Lancet Neurology

605

370

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Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.Rehabilitation of patients with hemiplegia after stroke has been limited for decades by a lack of theory-driven strategies leading to successful clinical trials with improvement in motor skills for daily activities. Recent therapeutic approaches have begun to build on methods to manipulate the remarkable adaptability or plasticity of the brain in response to task-specific practice, drugs, robotic trainers, and other ways to augment motor learning. 1 In this review, I offer conceptual bases for a clinical science of neurorehabilitation and emphasise mechanisms and procedures to improve walking and arm movement to lessen disability and limitations in daily life. One goal is to diminish the pessimism of physicians regarding the effect of additional rehabilitation and to provide them with sensible advice to offer patients who seek to improve motor skills at any time after stroke. Patients with sensorimotor and visual-field loss are much more dependent on carers than those with pure motor impairments, but even the latter may walk too slowly to participate in out-of-home activities or may be unable to integrate the use of an affected arm into personal care.Rehabilitation for hemiplegic stroke includes organised multidisciplinary, supportive services that begin 48 h after onset in stable patients. Inpatient and outpatient rehabilitation works to the advantage of patients and families in a general sense, but the effectiveness of each component of care falls short of evidence-based practice standards. The training of patients to compensate with the unaffected arm or leg has been a mainstay of rehabilitation. Physical, occupational, and speech therapists ...

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“…Also, treadmill gait training is used for rehabilitation of stroke patients or patients who have gait disturbances clinically [19]. Treadmill gait training enables patients to perform symmetric gait as they support their body weight.…”

Section: Introductionmentioning

confidence: 99%

The effect of treadmill gait training with patellar taping on gait abilities in chronic stroke patients

Shin

Chung

2015

PTRS

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Objective: The purpose of this study is to investigate the effect of treadmill gait training with patellar taping on gait abilities in chronic stroke patients. Design: Randomized controlled trial. Methods: Thirty chronic stroke patients who have been diagnosed at least six months or before were recruited in Gyeongin Rehabilitation Center Hospital, located in Incheon. Patients who were enrolled in this study were randomized to experimental group (n=15) or control group (n=15). Treadmill with patella taping training group patients were applied with patellar taping when they were being trained on a treadmill. Control group patients were being trained on a treadmill without any kind of taping. Gait parameters were measured with a GAITRite Ⓡ system which evaluated gait performances. Gait trainings were done for 30 min/day, 5 days/week, for 4 weeks. Results: After treadmill training, treadmill with patella taping training group showed a significant improvement in gait abilities, including velocity, cadence, paretic and non-paretic step length, and double support period (p<0.05). However, in general treadmill group, there were no significant differences in gait parameters except velocity and cadence. There was a significant difference in gait performance in the experimental group compared with the control group, except for the gait symmetry ratio (p<0.05). Conclusions: According to this result of this study, it seems that application of patellar taping in treadmill gait training for chronic stroke patients significantly improved gait abilities of these patients. Also, we can conclude that patella taping is thought to be useful in real clinical settings where there are many chronic patients who are in need of improvement in their gait abilities.

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Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support

Cited by 298 publications

References 12 publications

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

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

Strategies for stroke rehabilitation

The effect of treadmill gait training with patellar taping on gait abilities in chronic stroke patients

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