Treadmill Training with Partial Body Weight Support: Influence of Body Weight Release on the Gait of Hemiparetic Patients

Abstract

Objective: To investigate the effect of body weight support on the gait of hemiparetic subjects walking on a treadmill. Design: Survey. Patients: Eleven nonambulatory hemiparetic subjects. Methods: Subjects walked on the treadmill with full weight bearing and with 15%, 30%, 45%, and 60% body weight support at constant walking velocity. Cycle parameters, symmetry ratios, and the kinematic EMG of several lower limb muscles of the affected leg were recorded. Video-analysis served for assessment of posture and hip and knee angle displacement. Results: With body weight support the relative double support time decreased, the relative single stance period of the affected limb increased, and the functional activity of the vastus and soleus diminished. The activity of the gluteus tended to increase. Patients walked more upright and with less hip and knee flexion. The extensor spasticity did not change and the qualitative activation pattern of all recorded muscles remained unchanged. Conclusion: Body weight support did not facilitate a less physiological gait. By reducing double support duration, body weight support resulted in a greater stimulus for balance training. The facilitation of gluteus medius is favorable with respect to training pelvic alignment. The reduction of the activity of other antigravity muscles suggests a limit of 30% BWS not be exceeded.

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

“…12,13 Loading and unloading in the correct rhythm and hip extension during terminal stance phase were the major peripheral drives. [14][15][16] One of the disadvantages of treadmill training was the effort for up to three therapists in lifting the paretic limbs, promoting hip extension, and assisting lateral weight transfer; this limits its use in routine clinical practice. To reduce the physical effort required of therapists, Hesse and Uhlenbrock designed an electromechanical gait trainer.…”

Driving electromechanically assisted Gait Trainer for people with stroke

“…The GT Handbook suggested a maximum BWS of 35 percent for nonambulatory patients with hemiparesis and a maximum of 10 percent in patients walking with aid, including support [19]. Furthermore, clinical studies have recommended BWS limits of 30 percent on the treadmill [12] and 40 percent on the Lokomat ® [23] for maintaining the activity of antigravitational muscles. In contrast, a review on treadmill parameter selection stated that adequate support was 35 to 50 percent [18].…”

“…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.…”

Effects of intensive gait-oriented physiotherapy during early acute phase of stroke

“…We progressed training by increasing the speed of the gait trainer and aiming for a BWS of <20 percent body weight [23][24]. Reducing the BWS as the training progresses is important for effective and progressive activation of the lower-limb muscles and increased energy expenditure [25][26][27]. Previous studies have indicated that retraining gait with BWS leads to successful recovery of walking in patients with stroke and that progressively decreasing BWS improves walking more effectively [3,28].…”