The use of body weight support on ground level: an alternative strategy for gait training of individuals with stroke

<p>Abstract</p> <p>Background</p> <p>Body weight support (BWS) systems on treadmill have been proposed as a strategy for gait training of subjects with stroke. Considering that ground level is the most common locomotion surface and that there is little information about individuals with stroke walking with BWS on ground level, it is important to investigate the use of BWS on ground level in these individuals as a possible alternative strategy for gait training.</p> <p>Methods</p> <p>Thirteen individuals with chronic stroke (four women and nine men; mean age 54.46 years) were videotaped walking on ground level in three experimental conditions: with no harness, with harness bearing full body weight, and with harness bearing 30% of full body weight. Measurements were recorded for mean walking speed, cadence, stride length, stride speed, durations of initial and terminal double stance, single limb support, swing period, and range of motion of ankle, knee, and hip joints; and foot, shank, thigh, and trunk segments.</p> <p>Results</p> <p>The use of BWS system leads to changes in stride length and speed, but not in stance and swing period duration. Only the hip joint was influenced by the BWS system in the 30% BWS condition. Shank and thigh segments presented less range of motion in the 30% BWS condition than in the other conditions, and the trunk was held straighter in the 30% BWS condition than in the other conditions.</p> <p>Conclusion</p> <p>Individuals with stroke using BWS system on ground level walked slower and with shorter stride length than with no harness. BWS also led to reduction of hip, shank, and thigh range of motion. However, this system did not change walking temporal organization and body side asymmetry of individuals with stroke. On the other hand, the BWS system enabled individuals with chronic stroke to walk safely and without physical assistance. In interventions, the physical therapist can watch and correct gait pattern in patients' performance without the need to provide physical assistance.</p

Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study

<p>Abstract</p> <p>Background</p> <p>It is not yet established if the use of body weight support (BWS) systems for gait training is effective <it>per se </it>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

Muscle Atrophy and Functional Deficits of Knee Extensors and Flexors in People With Chronic Stroke

Background. Further clarification is needed with regard to the degree of atrophy in individual muscle groups and its possible relationship to joint torque deficit poststroke. Objective. The purpose of this study was to investigate quadriceps and hamstring muscle volume and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared with a control group. Design. This was a cross-sectional study. Methods. Thirteen individuals with hemiparesis due to chronic stroke (hemiparetic group) and 13 individuals who were healthy (control group) participated in this study. Motor function, quadriceps and hamstring muscle volume, and maximal concentric and eccentric contractions of the knee extensors and flexors were assessed. Results. Only the quadriceps muscle of the paretic limb showed reduced muscle volume (24%) compared with the contralateral (nonparetic) limb. There were no differences in muscle volume between the hemiparetic and control groups. The peak torque of the paretic-limb knee extensors and flexors was reduced in both contraction modes and velocities compared with the nonparetic limb (36%-67%) and with the control group (49%-75%). The nonparetic limb also showed decreased extensor and flexor peak torque compared with the control group (17%-23%). Power showed similar deficits in strength (12%-78%). There were significant correlations between motor function and strength deficits (.54-.67). Limitations. Magnetic resonance imaging coil length did not allow measurement of the proximal region of the thigh. Conclusions. There were different responses between quadriceps and hamstring muscle volumes in the paretic limb that had quadriceps muscle atrophy only. However, both paretic and nonparetic limbs showed knee extensor and flexor torque and power reduction.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), BrazilFundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), Sao Paulo, Brazil [2007/04503-6]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), BrazilConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), BrazilFAPESPFAPES