Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study
Journal of NeuroEngineering and Rehabilitation
during overground walking for individuals with chronic stroke: a pilot study
Catarina O Sousa
Jos A Barela
Christiane L Prado-Medeiros
Tania F Salvini
Ana MF Barela
Open Access
Gait training with partial body weight support
during overground walking for individuals with
chronic stroke: a pilot study
Background: It is not yet established if the use of body weight support (BWS) systems for gait training is effective
per se or if it is the combination of BWS and treadmill that improves the locomotion of individuals with gait
impairment. This study investigated the effects of gait training on ground level with partial BWS in individuals with
stroke during overground walking with no BWS.
Methods: Twelve individuals with chronic stroke (53.17 7.52 years old) participated of a gait training program
with BWS during overground walking, and were evaluated before and after the gait training period. In both
evaluations, individuals were videotaped walking at a self-selected comfortable speed with no BWS. Measurements
were obtained for mean walking speed, step length, stride length and speed, toe-clearance, durations of total
double stance and single-limb support, and minimum and maximum foot, shank, thigh, and trunk segmental
angles.
Results: After gait training, individuals walked faster, with symmetrical steps, longer and faster strides, and
increased toe-clearance. Also, they displayed increased rotation of foot, shank, thigh, and trunk segmental angles
on both sides of the body. However, the duration of single-limb support remained asymmetrical between each
side of the body after gait training.
Conclusions: Gait training individuals with chronic stroke with BWS during overground walking improved walking
in terms of temporal-spatial parameters and segmental angles. This training strategy might be adopted as a safe,
specific and promising strategy for gait rehabilitation after stroke.
Background
Typically, individuals with stroke walk slower than their
peers and present asymmetry in spatial-temporal
parameters [1,2] and joint angles [3]. These typical
characteristics may influence the return of pre-stroke
conditions [4], mainly because there exists an increased
risk of falling [5], followed by decreases in autonomy,
and consequently, an increase in social isolation [6,7].
Therefore, reestablishing independence via walking is a
crucial goal of any rehabilitation program for individuals
with stroke [3,4,8].
* Correspondence:
3Graduate Program in Human Movement Sciences, Institute of Physical
Activity and Sport Sciences, Cruzeiro do Sul University, So Paulo, SP, Rua
Galvo Bueno, 868, 13 andar, Bloco B, 01506-000, So Paulo, SP, Brazil
Full list of author information is available at the end of the article
Among the different strategies of gait training for
individuals with stroke, the use of a partial body weight
support (BWS) system has continued to gain popularity
[9-13]. This strategy of gait training originated from
experiments on animals with complete spinal cord
transections [14,15], which established that training on a
treadmill promotes the generation of an automatic
locomotor pattern by spinal neurons [16,17], named the
central pattern generator. Gait training humans affected
by stroke using a BWS system on a treadmill increased
walking speed and endurance when compared to
conventional gait training overground [9] or when using
only a treadmill [10].
A BWS system alleviates the body weight of the lower
limbs symmetrically [10,18,19], promotes stabilization of
the trunk [20], improves balance control, and avoids
falls [16]. Most studies had adopted 30% of a subjects
body weight unloading due to this percentages
effectiveness on gait training [9,12,21,22]. Additionally, the type
of training surfaces used by patients is crucial, and this
consideration may facilitate skill transfer to daily life
activities [23,24]. To our knowledge, no one has
evaluated the effects of gait training with partial BWS during
overground walking on the walking performance of
individuals with stroke. Previous studies concerning BWS
during overground walking investigated changes in gait
patterns but not its training effects [22,25-27].
Therefore, the purpose of this study was to investigate the
effects of gait training on ground level with partial BWS
on temporal-spatial parameters and on lower limb and
trunk segmental angles of individuals with chronic
stroke during overground walking without BWS. It was
hypothesized that these individuals gait performance
would improve after six weeks of the proposed gait
training and they would experience reduced asymmetry.
Methods
Participants
Twenty individuals with chronic stroke discharged from
a conventional rehabilitation program at a physical
therapy clinic at the university where this study took place
volunteered for this study. After an initial evaluation,
which occurred one week before the initiation of gait
training and consisted of p (...truncated)