Treadmill Training With Partial Body Weight Support and an Electromechanical Gait Trainer for Restoration of Gait in Subacute Stroke Patients

Abstract

Background and Purpose-The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. Methods-This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern.A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. Results-The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (Pϭ0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. Conclusions-The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

“…Werner et al 21 reported some augmented improvement with Gait Trainer exercises, which was trending toward significance. We were, however, unable to reproduce these effects, probably as a result of different patient samples (in our group, median FAC 0 and Werner median FAC 1) rather than the type of orthosis device used.…”

Driving electromechanically assisted Gait Trainer for people with stroke

“…The BWS s was reduced as soon as the patient could take his/her full weight, and the WS s was increased as soon as the patient could perform the task without overstraining and/or experiencing discomfort [5]. The physiotherapist involved in the GT treatment prepared the patients, chose the parameters, provided verbal feedback to the patient during the GT session, and manually controlled the patients' paretic knee, if needed.…”

“…The effectiveness of these devices has been investigated in patients with subacute [3][4][5] and chronic [6][7] stroke, but their overall efficacy has been questioned [8][9]. The absence of a general agreement may be due to differences among patients enrolled in these studies, as well as the lack of a unified approach to integrating these devices into rehabilitation programs [10].…”

“…Currently, therefore, training protocols vary widely among clinical trials. Low percentages of BWS and fast WSs may activate the relevant weightbearing muscles and improve locomotor efficiency [11][12] but can overstrain patients [5]. Despite every physiotherapist's concern for selecting the maximum parameter values that each patient can achieve without discomfort, clear guidelines and/or scientific analyses of these values are still lacking, as well as knowledge of their interrelationships and their effects on over-ground walking performance.…”

“…However, a common standing posture with both lower limbs extended is impossible on the GT, because when one plate is down (simulating the stance phase) the other is up (simulating the swing phase). Furthermore, the effective BWS (BWS e ) varies during the session, depending on the patient's capacity to sustain his/her own unsupported percentage of weight [5,17]. Despite these features, all previous studies on the GT have reported BWS s only, without describing the position at which it was selected.…”