Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke .
QUESTION Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke ?
Gait rehabilitation machines based on programmable footplates
Background Gait restoration is an integral part of rehabilitation of brain lesioned patients . Modern concepts favour a task-specific repetitive approach , i.e. who wants to regain walking has to walk , while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before . Following the first mobilization out of the bed , the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible . Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing . Results With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time . Controlled trials in stroke and SCI patients , however , failed to show a superior result when compared to walking exercise on the floor . Most likely explanation was the effort for the therapists , e.g. manually setting the paretic limbs during the swing phase result ing in a too little gait intensity . The next steps were gait machines , either consisting of a powered exoskeleton and a treadmill ( Lokomat , AutoAmbulator ) or an electromechanical solution with the harness secured patient placed on movable foot plates ( Gait Trainer GT I ) . For the latter , a large multi-centre trial with 155 non-ambulatory stroke patients ( DEGAS ) revealed a superior gait ability and competence in basic activities of living in the experimental group . The HapticWalker continued the end effector concept of movable foot plates , now fully programmable and equipped with 6 DOF force sensors . This device for the first time enables training of arbitrary walking situations , hence not only the simulation of floor walking but also for example of stair climbing and perturbations . Conclusion Locomotor therapy is a fascinating new tool in rehabilitation , which is in line with modern principles of motor relearning promoting a task-specific repetitive approach . Sophisticated technical developments and positive r and omized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients
Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke .
QUESTION Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke ?