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Body weight supported (BWS) treadmill training is a rehabilitation technique used to help people relearn how to walk. During this therapy, the patient is secured in a harness that is suspended from a frame or ceiling. This harness reduces the weight on their legs and feet as they walk on the treadmill. The level of support can be adjusted based on the patient’s progress, increasing or decreasing as needed.

For instance, if the treadmill speed is increased, more BWS may be required temporarily to help the patient maintain balance and proper posture.

BWS treadmill training is especially beneficial for individuals who have difficulty walking after a stroke. It offers a safe way for them to practice walking when they are not yet able to do so independently. By providing support, BWS allows some patients to begin walking earlier in their recovery process.

Implementing BWSTT for stroke patients

Body Weight Supported Treadmill Training in Neurological Rehabilitation

Implementing Body Weight Supported Treadmill Training for stroke patients involves several key steps. Here is a general outline of how to implement this training:

1. Initial Assessment

• Medical Evaluation: Ensure the patient is medically stable and has clearance to begin intensive physical therapy.

• Functional Assessment: Evaluate the patient’s current mobility, strength, balance, and endurance levels.

2. Setting Up the Equipment

• Body Weight Support System: This system helps reduce the load on the patient’s legs, making it easier to practice walking.

• Motorized Treadmill: Adjust the speed and incline to match the patient’s ability and gradually increase the challenge. Make sure the harness is tight and stable for proper balance and support. 3. Training Protocol

• Warm-Up: Begin with gentle stretching and range-of-motion exercises.

• Treadmill Training: Start with the patient in the harness, providing enough support to allow them to walk with proper form.

• Initial Sessions: Focus on short durations (e.g., 10-15 minutes) at a slow speed.

• Focus on proper walking technique: teach the patient heel to toe walking with keeping upright posture and coordinating arm and leg movements.

• Progression: Gradually increase the duration and speed as the patient gains strength and confidence.

• Overground Training: Complement treadmill sessions with overground walking practice to help transfer skills to real-world settings.

4. Therapist Involvement

• Manual Assistance: Therapists may need to manually assist with leg movements and balance initially.

• Feedback and Adjustment: Continuously monitor the patient’s form and provide feedback. Adjust the level of support and treadmill settings as needed.

5. Repetition and Consistency

• Frequent Sessions: Aim for multiple sessions per week to maximize neuroplasticity and functional gains.

• Task-Specific Training: Focus on walking-related tasks to improve gait patterns and endurance.

6. Monitoring and Evaluation

• Regular Assessments: Periodically reassess the patient’s progress and adjust the training plan accordingly.

• Outcome Measures: Use standardized tools to measure improvements in walking speed, distance, and overall mobility.

7. Safety Considerations

• Maintain constant observation of the patient's vital signs in order to avoid fatigue.

• Supervision: Ensure a trained therapist is always present to prevent falls and manage any complications.

• Patient Comfort: Adjust the harness and treadmill settings to ensure the patient is comfortable and secure.

Advantages

• Enhanced Stability and Coordination: Improvements in balance and motor coordination, leading to increased functional independence.

• Improve The Gait and Walking Speed: Facilitation of more efficient ambulation and increased velocity in walking patterns.

• Reduced Fall Risk: Decreased likelihood of falls, contributing to overall safety and well-being.

• Minimize Compensatory Movements: Reduction in maladaptive movement patterns that can lead to injury or functional decline. • Cardiovascular Health Benefits: Promotion of cardiovascular fitness through increased physical activity levels.

• Early Mobilization Facilitation: Encouragement of timely mobilization to prevent complications associated with prolonged immobility.

• Higher Intensity Practice Opportunities: Provision of environments conducive to engaging in higher intensity training regimens.

• Neuroplasticity Enhancement: Stimulation of neuroplastic changes, facilitating recovery and skill acquisition.

• Psychological Benefits: Improvement in mental well-being, including reduced anxiety and enhanced mood.

• Customizable Training Protocols: Development of tailored training programs that adapt to the individual patient’s progress and needs.

Side effects:

• dizziness

• faintness

• diaphoresis

• Muscle fatigue

Limitations:

• The patient needs a supervisor for treatment.

• Risk of overuse injuries

• Patient suitability

Disadvantages:

• This therapy may be less accessible in low-resource environments due to its dependence on specific equipment, such as a treadmill and harness system.

• The cost of treadmill training is significantly higher due to the high cost of the necessary equipment for body weight support.

• Restricted availability.

• Patients may develop less effective walking in natural environments due to their overreliance on treadmills, slowing the transition to overground walking.