From Jewish Rehabilitation Hospital, Laval (M.V., N.K.-B); School of
Physical and Occupational Therapy (H.B., N.K.-B., N.E.M.) and Department of
Epidemiology (N.E.M.), McGill University, Montreal; and Royal Victoria
Hospital, Montreal (N.E.M.), Quebec, Canada.
Methods—One hundred subjects with stroke were randomized to
receive one of two treatments while walking on a treadmill: 50 subjects
were trained to walk with up to 40% of their body weight supported by
a BWS system with overhead harness (BWS group), and the other 50
subjects were trained to walk bearing full weight on their lower
extremities (no-BWS group). Treatment outcomes were assessed on the
basis of functional balance, motor recovery, overground walking speed,
and overground walking endurance.
Results—After a 6-week training period, the BWS group scored
significantly higher than the no-BWS group for functional balance
(P=0.001), motor recovery (P=0.001),
overground walking speed (P=0.029), and overground
walking endurance (P=0.018). The follow-up evaluation, 3
months after training, revealed that the BWS group continued to have
significantly higher scores for overground walking speed
(P=0.006) and motor recovery
(P=0.039).
Conclusions—Retraining gait in patients with stroke while a
percentage of their body weight was supported resulted in better
walking abilities than gait training while the patients were bearing
their full weight. This novel gait training strategy provides a dynamic
and integrative approach for the treatment of gait dysfunction after
stroke.
Animal studies have shown that the adult spinal cat can recover a
near-normal walking pattern after a period of interactive locomotor
training in which weight support for the hindquarters is provided,
hence facilitating stepping on a treadmill.8 9 10
On the basis of these studies, we developed a gait training strategy
for patients with neurological conditions that involves the use of BWS
during gait training on a treadmill.11 12 13 14 15 This
novel approach consists of using an overhead suspension system and
harness to support a percentage of the patient's body weight as the
patient walks on a treadmill and progressively decreasing the amount of
body weight supported as the gait pattern improves. BWS provides
symmetrical removal of weight from the lower extremities, thereby
facilitating walking in patients with neurological conditions who are
typically unable to cope with bearing full weight on their lower limbs.
This strategy encompasses several principles that favor the recovery of
locomotor abilities after a stroke. It minimizes the delay during which
gait training can be initiated since patients are provided with the BWS
needed to begin walking very early in the rehabilitation process. This
strategy provides a dynamic and task-specific approach that integrates
three essential components of gait while the patient is walking on the
treadmill: weight bearing, stepping, and
balance.16 The treadmill stimulates repetitive
and rhythmic stepping with the patient supported in an upright position
and bearing weight on the lower limbs. Gait training during actual
walking favors a better recovery of walking abilities than a more
conventional approach that emphasizes control of isolated components of
gait before ambulation is resumed.17 18 Moreover,
providing BWS by symmetrically unloading both lower extremities creates
an environment that discourages the development of compensatory
strategies compared with gait training with walking aids, which favors
an asymmetrical gait pattern.14 18
Preliminary studies suggest that the use of BWS leads to a better
recovery of ambulation, with effects on overground walking speed,
endurance, and physical assistance required to
walk.6 12 19 20 21 Chronic, nonambulatory patients
with stroke and spinal cord injuries have been reported to regain the
ability to walk after a course of gait training with
BWS.15 19 20 21 Patients with stroke were also
reported to have recovered better walking abilities with this approach
than with the more conventional Bobath
approach,22 which focuses on weight-bearing and
weight-shifting activities in preparation for
gait.6 These recent studies report comparisons
between conventional gait training and a combination of BWS and
treadmill training. Although the results suggest that BWS and treadmill
training enhance locomotor recovery, the contribution of BWS in
retraining gait has not been addressed. Further investigation is needed
to determine whether unloading of the lower limbs, as well as
progressively increasing weight bearing during training, contributes to
the improvement in gait being reported.
The objective of the present study was to evaluate the
effectiveness of BWS in retraining gait in patients with stroke. A
randomized clinical trial was performed in which one group of stroke
patients received gait training on the treadmill with BWS and one group
received training on the treadmill with no BWS (under full
weight-bearing conditions). Clinical outcome measures on balance, motor
recovery, overground walking speed, and endurance were compared after 6
weeks of training and at a 3-month follow-up. The hypothesis was that
subjects trained to walk with BWS would show greater improvements in
gait than those trained to walk without BWS at the end of a 6-week
training period and at a 3-month follow-up.
Experimental and Control Groups
The overhead harness (Figure 1
Both groups received gait training for 6 weeks at a frequency of four
times per week. Gait training was performed by the subject's treating
therapist in the physiotherapy department. During each session the
patients were allowed to walk for a maximum of three trials and for a
total duration not exceeding 20 minutes. The subject's pulse and heart
rate were monitored before initiation of each session and again after
each trial to ensure that it not surpass a baseline established by the
physician. The treadmill used (Burdick T500 model) permitted walking to
be initiated from 0.0 mph and increased by increments of 0.1 mph. The
subject could also hold onto a horizontal bar attached to the front of
the treadmill for stability. In addition to gait training, all subjects
included in the trial, regardless of group allocation, received regular
weekday physiotherapy aimed at maximizing function.
Training Strategy
Subjects in both groups were trained with the assistance of one or two
therapists, as needed. For the more impaired subjects, training was
carried out with two therapists. One therapist stood behind the subject
with the therapist's feet on either side of the treadmill and provided
assistance for proper trunk alignment and weight shifting while the
subject walked. The second therapist was positioned beside the
hemiplegic lower limb and assisted with stepping and limb control
during the stance and swing phases.
During training other variables were manipulated, including
treadmill speed and use of the horizontal bar to increase stability.
Treadmill speed was increased as the subject's walking ability
improved with training. In the first sessions after the increase in
speed, it was sometimes necessary to augment BWS to facilitate walking
at the higher speed. Once the subject was accustomed to the higher
speed, the percentage of BWS was once again decreased. For subjects in
the no-BWS group, treadmill speed was also increased as their gait
improved and they were able to walk at faster speeds.
Subjects in both the BWS and no-BWS groups who progressed to walking
well on the treadmill were trained to walk without using the
treadmill's horizontal bar for support to stimulate balance and
postural responses. For subjects in the BWS group, BWS was initially
increased to facilitate walking without holding on and was decreased as
they were able to accomplish this with more ease.
Measurement Tools
Outcome Variables
When overground walking speed and endurance were measured, the subjects
were allowed to use the walking aids they required and were given the
assistance necessary to compensate for lack of balance.
Confounding and Explanatory Variables
Statistical Analyses
Table 2
Subjects Lost to Study
When subjects who failed to complete the study and those who completed
all 24 sessions were compared, a distinct profile emerged (Table 3
Effectiveness of BWS
The 79 subjects who completed the training protocol were contacted for
a follow-up evaluation at 3 months after training. Of these, 52 (66%)
were available to participate in the follow-up evaluation. Twenty-seven
subjects were lost for reasons including a medical event or a repeated
stroke, lack of willingness to participate, or a move out of the
province. Of the 52 subjects reevaluated, 29 were in the BWS group and
23 were in the no-BWS group. The subjects were reevaluated on all four
outcome variables. As illustrated in Figure 2
Time to Initiate Gait Training
The average (mean±SD) length of training received each day was
comparable in both groups (BWS, 14.7±4.2 minutes; no-BWS, 14.4±3.8
minutes). This included time spent on standing activities on the
treadmill for those subjects in the no-BWS group who were too impaired
to walk. The average length of walking on the treadmill was slightly
higher for the BWS group (BWS, 14.7±4.2 minutes; no-BWS, 13.7±5.0
minutes) but not significantly different.
Percentage of BWS and Treadmill Speed
There were differences in the initial treadmill speed used for training
in both groups. The average initial treadmill speeds for training for
the BWS and no-BWS groups were 0.52±0.25 and 0.43±0.31 mph,
respectively. By week 6 the training treadmill speed continued to be
more elevated in the BWS group (0.95±0.49 mph) than in the no-BWS
group (0.76±0.42 mph).
Although not everyone completed the training protocol as desired, the
results of this study are still indicative of greater benefit for the
BWS group. The reasons for dropping out did not appear to be related to
baseline characteristics since dropouts and persons who completed the
training protocol did not differ in this respect. There were more
dropouts in the no-BWS group, primarily for medical reasons and because
of unwillingness to continue. Indeed, it has been shown to be more
taxing to walk on a treadmill with no BWS; subjects with neurological
conditions were able to walk for longer periods and with less elevated
heart rates when walking with BWS.13 Thus, even
if we were able to perform an intention-to-treat analysis by
keeping all subjects in their groups as determined by the randomization
regardless of adherence, this type of analysis would likely
indicate an even greater benefit of BWS.
The present study differs from earlier
studies6 19 in that both groups received daily
task-specific gait training on the treadmill, with the use of BWS being
the only difference between the experimental and control groups.
Ultimately, the BWS group had significantly better gait outcome than
the no-BWS group, supporting the hypothesis that partially unloading
the lower limbs during training and progressively increasing the load
as the gait pattern improves will enhance the recovery of locomotion.
The better walking abilities cannot be attributed to the BWS group
receiving more gait-specific training because the two groups did not
differ in terms of the amount of time spent gait training. Thus, the
benefits of retraining gait with BWS appear to be derived from the
effects of BWS. Unloading the lower extremities appears to be an
important factor in unmasking the potential for the recovery of
gait.
The results of our study suggest that the improvements in gait achieved
during supported locomotion can be sustained and transferred to full
weight–bearing overground walking after a training regimen, ultimately
resulting in a more functional gait with better balance, motor
function, and overground walking speed and endurance. It is important
to note that in this study the posttraining gait outcomes reported for
walking speed and endurance were measured over ground and not on the
treadmill, where the subjects had been trained. Subjects in the BWS
group were able to train at higher treadmill speeds than subjects in
the no-BWS group. Training at faster walking speeds on the treadmill
may have resulted in the faster overground walking speeds. This would
imply that there is some carryover between the treadmill training and
overground walking.
Clinical Relevance of BWS Training
One of the major advantages of using BWS is that task-specific gait
training can be started during the very early days of rehabilitation by
providing patients as much weight support as needed to compensate for
their inability to assume an upright position while stepping forward.
In this study all subjects randomized to the BWS group were able to
walk on the treadmill from the first day in the study. In the no-BWS
group, there were three subjects not able to step on the moving
treadmill, and gait training was delayed between 9 and 23 days. This
has major implications for those patients who are very impaired and
thus difficult to gait train, sometimes requiring up to three
therapists to walk a short distance over ground. For these patients,
BWS and treadmill can be used to provide early and intensive
task-specific gait training that will potentiate their locomotor
recovery.7 11 17 If chronic nonambulatory
patients with neurological conditions can resume ambulation after
training with BWS and treadmill, as reported by several
authors,15 19 20 21 this training strategy should
have a substantial impact when implemented during the acute phase of
rehabilitation when there is the most plasticity and potential for
recovery.
During this clinical trial, 79% of the patients progressed to train at
full weight bearing by the end of the 6-week period, a time span
similar to that reported by Hesse et al.19 This
is an important factor because a 6-week time frame makes this strategy
a realistic intervention for a rehabilitation program.
Conclusions
Received December 19, 1997;
revision received March 20, 1998;
accepted March 20, 1998.
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© 1998 American Heart Association, Inc.
Original Contributions
A New Approach to Retrain Gait in Stroke Patients Through Body Weight Support and Treadmill Stimulation
Abstract
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Background and Purpose—A new gait
training strategy for patients with stroke proposes to support a
percentage of the patient's body weight while retraining gait on a
treadmill. This research project intended to compare the effects of
gait training with body weight support (BWS) and with no body weight
support (no-BWS) on clinical outcome measures for patients with
stroke.
Key Words: hemiplegia • rehabilitation • stroke management • treatment outcome
Introduction
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Over the past 10
years, an estimated 335 000 Canadians have suffered a
stroke.1 More than one half of those who survive
the acute phase are not able to walk2 3 4 and will
require a period of rehabilitation to achieve a functional level of
ambulation. Both animal research and, more recently, human studies have
shown that the type of training strategy adopted to retrain walking
after injury in patients with neurological conditions can significantly
influence the degree of locomotor recovery.5 6 7 A
recently proposed gait training strategy involves unloading the lower
extremities by supporting a percentage of body weight. It is the intent
of this research project to compare the effects of gait training
with body weight support (BWS) and without BWS on functional outcomes
in stroke patients.
Subjects and Methods
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Subjects
A total of 375 patient admissions to the Jewish Rehabilitation
Hospital for physical rehabilitation after stroke were reviewed between
October 1992 and January 1995. The average age of the group was 69.2
years (range, 27 to 93 years), and 45.6% were women. Of the 375
admissions, 251 were not eligible. Two hundred thirty-seven admissions
did not meet the inclusion criteria for reasons outlined in Table 1
. Fourteen additional subjects were not
recruited: the treadmill was overbooked (n=6), and at one point high
functional walkers were not sought (n=8). One hundred twenty-four
subjects with right or left cortical stroke were eligible; 24 refused
to participate, and 100 subjects provided informed consent to
participate in this study, which had been approved by the hospital's
ethics committee. Those who refused to participate were slightly older
(70.1±12.2 years) than those who participated (67.3±11.7
years).
View this table:
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Table 1. Patients Admissions Excluded From Study After
Initial Screening for Eligibility (n=237) and Reasons for
Exclusion
The 100 subjects were randomized into one of two groups: the
experimental group (BWS, n=50) and the control group (no-BWS, n=50) by
block randomization within strata identified according to initial level
of ambulatory status (low/high). Low ambulatory status was defined as
nonambulatory or requiring maximal assistance to walk. High ambulatory
status was defined as needing moderate or minimal assistance or walking
independently with or without supervision but with residual gait
deviations. The experimental group received gait training on a
treadmill while an overhead harness supported a percentage of their
body weight. The control group received gait training on a treadmill
with no BWS, ie, while bearing full weight on their lower
extremities. ) consists
of a pelvic belt that attaches around the hips and two thigh straps
with anterior and posterior attachments to the pelvic
band.23 The harness vertically supports the
subject over the treadmill and is attached to a suspension system with
a force transducer that signals the amount of body weight supported by
the apparatus. Individuals in the BWS group were provided
up to 40% BWS at the beginning of training, and the percentage of BWS
was progressively decreased as the subject's gait pattern and ability
to walk improved. Subjects in the control group wore the harness as a
measure of security and to ensure similar experimental conditions
between the two groups, but no BWS was provided.
View larger version (111K):
[in a new window]
Figure 1. Anterior view of the body weight support system
composed of an overhead suspension system and harness that support the
subject vertically over the treadmill.
A gait training strategy for stroke patients using BWS and
treadmill had been developed earlier during a pilot study. The strategy
focuses on a straight trunk and limb alignment with proper weight shift
and weight bearing onto the hemiplegic limb during the loading phases
of gait as well as stepping to advance the limb forward. At the
initiation of training, the therapist observed the subject walking at
10%, 20%, 30%, and 40% BWS. The therapist then selected the percent
BWS that facilitated proper trunk and limb alignment and transfer of
weight onto the hemiplegic limb.
Measurements of two types of variables were made: (1)
outcome variables on which the effectiveness of the BWS system was
judged and (2) confounding variables that have been shown in the
literature to be associated with recovery of ambulation and function.
All subjects were evaluated before commencement of training and again
at the completion of the 6-week training period and at a 3-month
follow-up. All evaluations were done by a blinded evaluator who was not
aware of group assignment.
The BWS and no-BWS groups were compared in terms of balance,
motor recovery, overground walking speed, and overground walking
endurance. Balance was assessed with the use of the Balance Scale, a
scale that evaluates 14 sitting and standing activities, each on a
5-point scale.24 The maximum score is 56, with
higher scores indicating better balance. It has been tested on patients
with stroke and has a good interrater and intrarater reliability (0.98
and 0.99, respectively).25 Motor recovery
was assessed with the use of the lower extremity portion of an early
version of the Stroke Rehabilitation Assessment of Movement (STREAM), a
25-item scale evaluated on a 4-point scale for some items and on a
2-point scale for other items.26 More
specifically, the STREAM evaluates voluntary movement of the limbs and
basic mobility. The maximum score is 55, with higher scores signaling
better function. Overground walking speed was measured in meters per
second as the subject walked across a 10-m walkway. The walking speed
was recorded with the use of a stopwatch over the middle 3 m
of the walkway. When the subjects had sufficient endurance, they were
requested to complete the 10-m walk three times, and the average of the
three trials was recorded as the speed. Overground endurance was
measured by asking the subjects to walk back and forth along the 10-m
walkway until they were unable to continue. The subject was permitted
to continue up to a maximum distance of 320 m.
Information on age, sex, side of lesion, time since stroke,
previous strokes, and other comorbidity, classified according to the
weighted scheme developed by Charlson et al,27
was abstracted from the medical dossier. Information on cognitive
status was measured by the 10-item Short Portable Mental Status
Questionnaire.28 The score was calculated on the
basis of a possible 10, with higher scores indicating better
functioning. Cognitive scores were not available for those subjects who
had communication difficulties associated with aphasia. Mood was
assessed with the use of the short 10-item version of the Zung
Self-Rating Depression Scale.29 Scores range from
25 to 100, with scores over 50 indicating the presence of
depression.
Descriptive statistics were used to compare the baseline
characteristics and the pretraining gait scores of the two study
groups. Descriptive information was also collected to determine the
characteristics of those who refused to participate and those who
failed to complete the study protocol. ANCOVA was used to determine
differences in the four clinical outcome measures across the two groups
at the end of the training period and at 3-month follow-up. The
covariates used were the level of ambulatory status (low/high) and the
pretraining score for each outcome variable.
Results
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Of the 100 subjects, 50 were randomized into the BWS group, and
the other 50 subjects were randomized into the no-BWS group. Of these,
79 completed the entire study protocol as defined by completion of all
24 training sessions. Forty-three subjects in the BWS group (86%) and
36 subjects in the no-BWS group (72%) completed the 24 training
sessions. outlines the characteristics and
the pretraining scores on the primary gait parameters of
the 100 subjects randomized into the BWS and no-BWS groups. The
pretraining scores for the 43 individuals in the BWS group and the 36
individuals in the no-BWS group who completed the training protocol (24
sessions) were also found to be similar (mean±SD score): balance
(23.6±15.2 versus 22.1±17.1), motor recovery (24.6±11.6 versus
22.1±17.1), overground walking speed (0.18±0.16 versus 0.17±0.18
m/s), and over-ground walking endurance (45.6±68.8 versus 51.6±82.5
m). In addition, their pretraining scores were similar for depression
(44.4±11.4 versus 44.5±14.3) and for cognitive status (8.5±1.6
versus 8.6±1.6).
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Table 2. Baseline Demographic Characteristics and Pretraining
Scores on Outcome Measures of the Body Weight Support and No–Body
Weight Support (no-BWS)
Groups
Of the 21 subjects who terminated their participation in the
study, 7 were from the BWS group and 14 from the no-BWS group. When
reasons for termination were explored, more losses were experienced in
the no-BWS group for medical reasons (BWS=2, no-BWS=5) and because of
an expressed unwillingness to continue training (BWS=2, no-BWS=4). Five
individuals were discharged to chronic care and were therefore no
longer eligible to participate (BWS=2, no-BWS=3). Three subjects were
discharged home (BWS=1, no-BWS=2) and were unwilling or unable to
complete the training. ). Those who did not complete the
training were older, more likely to be female, and had a greater number
of comorbidities but did not differ with respect to side of lesion,
depression, or cognitive status or on pretraining scores for balance,
motor recovery, overground walking speed, and endurance.
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[in a new window]
Table 3. Characteristics of Patients Who Completed the Study
(Training=24 Sessions) and Patients Who Failed to Complete the Study
(Training <24
Sessions)
The pretraining and posttraining scores for balance, motor
recovery, overground walking speed, and overground endurance were
compared for the BWS (n=43) and no-BWS (n=36) groups with the use of
ANCOVA, in which the pretraining scores and the low/high ambulatory
status were controlled as covariates. The analysis revealed
significant differences between the two groups on posttraining scores
for all four variables, as illustrated in Figure 2. There were significant differences
between the BWS and no-BWS groups (mean±SE score) for balance
(37.2±2.1 versus 29.4±3.1; P=0.001), motor recovery
(36.7±1.9 versus 29.3±2.6; P=0.001), overground walking
speed (0.34±0.04 versus 0.25±0.04 m/s; P=0.029), and
overground endurance (147.4±18.2 versus 105.0±18.7 m;
P=0.018).
View larger version (31K):
[in a new window]
Figure 2. Effects of body weight support (BWS) training on
the following outcome measures: balance (A), motor recovery (B),
overground walking speed (C), and overground walking endurance (D).
Group means and SEs are shown for the pretraining, posttraining, and
follow-up scores. ANCOVA (controlling for pretraining scores and
low/high ambulatory status) revealed significant differences for all
four outcome variables between the BWS and no-BWS (NBSW) groups
after training. The follow-up scores were significantly different
between the two groups for motor recovery and overground walking
speed. 
, subjects in both
groups showed improvements in balance, motor recovery, walking speed,
and endurance when the posttraining and follow-up scores were compared.
However, ANCOVA revealed significant differences between the
BWS and no-BWS groups (mean±SE score) for motor recovery (41.2±2.4
versus 34.4±3.4; P=0.039) and overground walking speed
(0.52±0.06 versus 0.30±0.06 m/s; P=0.006), whereas no
significant differences were found for balance (42.0±2.5 versus
35.8±3.6; P=0.058) and overground endurance (202.4±22.8
versus 152.3±29.4 m; P=0.065).
Another variable of interest in this study was the time to
initiate gait training, defined as the delay between the time the
subject entered the study and the time the subject was able to walk
rather than stand on the treadmill. All subjects in the BWS group were
able to walk on the treadmill from the first day of training, using up
to 40% BWS and the therapist's assistance for stepping. In the no-BWS
group, three subjects were not able to walk while bearing full weight
on the treadmill, even with the assistance of two therapists, and
walking was delayed. These subjects practiced standing activities on
the treadmill in preparation for walking. The three subjects initiated
walking on the treadmill on days 9, 11, and 23.
Figure 3 illustrates the percentage
of subjects using 0% to 40% BWS at different intervals during the
6-week training period. Initially, 72% of BWS subjects were using 30%
and 40% BWS. By weeks 3 and 4 a large percentage of subjects were
training at 0% to 20% BWS. At week 6, 79% of subjects trained at 0%
BWS, and this was accomplished, on average, within 13.1±7.4 days
(range, 2 to 23 days) of training.
View larger version (35K):
[in a new window]
Figure 3. Percentage of subjects using 0% to 40% body
weight support (BWS) during the first day of training, the first day of
the third and fourth weeks, and the last day of training. At the end of
the 6-week training period, 79% of subjects were training on the
treadmill at 0% BWS.
Discussion
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Gait Outcomes With BWS Training
The results of this randomized clinical trial indicate that
subjects with stroke who received 6 weeks of gait training with BWS
recovered better balance and walking abilities than those who received
similar gait training while bearing full weight on their lower
extremities. A 3-month posttraining follow-up revealed that subjects
trained with BWS continued to have significantly higher scores for
overground walking speed and lower limb motor recovery.
The subjects recruited for this study had significant gait
disabilities as profiled by the clinical measures of balance and
mobility recorded. In general, they presented with
attributes typical of subacute patients with stroke undergoing a
rehabilitation program. In stroke rehabilitation the use of the
treadmill is increasingly mentioned as an alternative method of gait
training, although it has yet to be widely used in clinical
settings.7 11 30 A relevant finding from this
study is that a large majority (79%) of these subjects were able to
complete the 6-week training regimen on the treadmill for both
paradigms, BWS or no-BWS. This suggests that treadmill gait training is
well tolerated by patients with stroke. There were some indications of
the type of patient not suitable for such training from the 21 subjects
who, for medical and other reasons, did not complete the 6 weeks of
training. These subjects were more often elderly female subjects with
multiple comorbid conditions. There were twice as many subjects in the
no-BWS as in the BWS group who stopped training because they did not
like this type of treatment for gait training.
This study shows that gait training on a treadmill with BWS is an
effective approach because it results in better locomotor abilities.
This type of training is well tolerated by patients with stroke and is
a training strategy that is compatible with rehabilitation practices in
a clinical setting. Indeed, since in this study the patient's regular
treating physical therapist completed the training, the results can be
generalized to other rehabilitation settings. Gait training with BWS
could be used in combination with other rehabilitation strategies such
as functional electrical stimulation31 to assist
walking and pharmacological approaches32 that may
enhance locomotor function in patients with neurological conditions.
Further research is needed to continue perfecting this strategy. It is
important to investigate whether recovery of gait would be further
enhanced during overground gait training with BWS. Identifying the
optimal period after the lesion during which to initiate this type of
training to maximize gait function is also important. In recent years
few new gait training strategies have been proposed for patients with
neurological conditions. This novel training strategy appears effective
in enhancing locomotor recovery and provides a dynamic and integrative
approach for the treatment of gait dysfunction after stroke.
Acknowledgments
This study was funded by the Heart and Stroke Foundation of
Canada and by the National Health Research and Development Program. The
authors would like to thank the physiotherapists at the Jewish
Rehabilitation Hospital, without whose dedication the completion of
this research project would never have been possible. We would also
like to thank Dr Joyce Fung for carefully reviewing the manuscript.
Footnotes
Reprint requests to Dr Hugues Barbeau, McGill University, School of Physical and Occupational Therapy, 3654 Drummond St, Montreal, Canada H3G 1Y5.
References
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
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