Partial Body Weight Supported Gait Training Post ABI

Author/Year/
Country/Study Design/
PEDro Score/N

Methods

Outcomes

Peters et al. (2014)
USA
Pre-Post
N=10

 

Population: TBI; Median Age=35.4yr; Gender: Male=6, Female=2; Median Time Post Injury=9.9yr.
Intervention: Participants went through 20 days of intensive mobility training (5d/wk for 4wk) to 50hr of therapy. Sessions included gait training with body-weight-supported treadmill, balance activities, and strength coordination and range of motion.
Outcome Measure: Berg Balance Scale, Dynamic Gait Index (DGI), 10m Walk Test, 6m Walk Test, 30s Sit-to-Stand test, Timed Up and Go (TUG) test, Walking While Talking Test average errors/ alternating letters, Falls Efficacy Scale (FES), Quality of Life after Brain Injury, Global Rate of Change Scale, and Fatigue.

 

  1. The average session was 150.1±2.7min.
  2. Fatigue scores ranged from 0 to 2.5 (out of 10) before sessions and 3 to 5.5 after.
  3. From pre-test to post-post significant changes were seen for the FES (p=0.01), DGI (p=0.049), 10m walk test (p=0.03), 10F (p=0.01), TUG (p=0.01), 6m walk test (p=0.03).
  4. From pre-test to follow-up (3mo), significant changes were shown for 10m walk test (p=0.02) and the TUG (p=0.03).

Esquenazi et al.
(2013)
USA
RCT
PEDro=5
N=16

 

Population: TBI; Gender: male=7, female=9. Robotic-Assisted Group (n=8): Mean Age=37.1yr; Mean Time Post Injury=140.3mo. Manually Assisted Group (n=8): Mean Age=41.9yr; Mean Time Post Injury=150.4mo.
Intervention: All participants received gait training for 45min, 3/wk for a total of 18 sessions. The training was either Robotic-Assisted Treadmill Training (RATT) or Manually Assisted Treadmill Training (MATT). 
Outcome Measure: Over ground walking self-selected velocity (SSV), maximal velocity, spatiotemporal symmetry, 6-minute walk test, and Stroke Impact Scale.

  1. From pre- to post-intervention, SSV increased by 49.8% (p=0.01), maximal velocity by 14.9% (p=0.01) step length asymmetry ration improved during SSV by 33.1% (p=0.01), and distance walked (6MWT) improved by 11.7% (p=0.21) in the RATT group.
  2. SSV increased by 31% (p=0.06), maximal velocity increased 30.8% (p=0.01), step-length asymmetry ratio improved during SSV by 9.1% (p=0.73), distance walked (6MWT) by 19.3% (p=0.03) in the MATT group.
  3. No significant between group differences were found.

     

Moriello et al. (2013)
USA
Pre-Post
N=5

Population: TBI; Mean Age=27.8yr; Gender: Male=1, Female=4; Mean Time Post Injury=6.4yr; Severity: Unspecified.
Intervention: Participants followed a 3-phase 15wk exercise program (1hr/d, 2d/wk). Phase 1 (6wk) consisted of strength, flexibility, balance, and agility exercises. Phase 2 (6wk) included body weight supported treadmill training. Phase 3 (3wk) included high level sport-specific drills. Outcomes were assessed at baseline and after each phase.
Outcome Measures: High Level Mobility Assessment Tool (HiMAT), Lower extremity hand held dynamometry (HHD), Running speed, Running distance, and Running quality.

 

  1. Mean HiMAT scores increased from 19.6 at baseline to 26.8 after the intervention.
  2. Mean running speed increased from 2.7 m/s at baseline to 3.1m/s after the intervention.
  3. Mean running distance increased from 384m at baseline to 1331m after the intervention.
  4. For running quality, participants showed improvements in weight bearing symmetry and upper extremity movement mechanics.
  5. HHD changes were inconsistent and varied between participants, but there was a trend toward increased strength in hip extensors, hip abductors, knee flexors, ankle dorsiflexors, and ankle plantarflexors. 

     

Clark et al. (2012)
Australia
Prospective Controlled Trial
N=42

 

Population: Experimental Group (n=17): TBI=11, Stroke=5, Multiple Sclerosis=1; Mean Age=38.7yr; Gender: Male=10, Female=7; Median Time Post Injury=9mo. Control Group (n=25): Healthy controls; Mean Age=27.8yr; Gender: Male=16, Female=9.
Intervention: All participants performed 7 alternative gait training methods in a randomized order. Methods included: therapist manual facilitation, use of gait assistive device, treadmill walking with handrail support, and 4 variations of body weight-support treadmill training with combinations of handrail and/or therapist support.
Outcome Measure: Mediolateral center of mass movement, stride time, and stability of movement.

 

 

*p-values not provided.

  1. Body weight-support treadmill training without any additional support result in significantly greater amplitude, altered timing, and reduced movement stability compared with nonpathologic gait.
  2. Manual facilitation by the therapist most closely matched nonpathologic gait for timing and stability.
  3. The use of therapist facilitation or handrail support reduced the effect and resulted in treadmill training having lower movement amplitudes when compared to other methods of training.

     

Wilson et al. (2006)
USA
RCT
PEDro=7
N=38

 

Population: TBI; Mean Age=29.6yr; Gender: Male=35, Female=3; Mean Time Post Injury: Experimental Group (n=19)=4mo, Control Group (n=19)=2.8mo.
Intervention: Patients in the control group received standard physical therapy for 8wk. The experimental group had physical therapy supplemented with partial weight-bearing gait training twice weekly.
Outcome Measure: Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Rivermead Mobility Index (RMI), Gross Motor Subscale (GMS), the Standing Balance Scale (SBC), and the Functional Ambulation Category (FAC). 

  1. The control group had significant improvements on the SBC (p<0.0039), FAC (p<0.0002), RMI (p<0.0001), GMS (p<0.0005), and FIM+FAM (p<0.0002).
  2. The experimental group had significant improvements on the SBC (p<0.002), FAC (p<0.0002), RMI (p<0.0009), GMS (p<0.0015), and FIM+FAM (p<0.0039).
  3. No between group differences were found for the SBC (p<0.687), FAC (p<0.922), RMI (p<0.855), GMS (p<0.927) or the FIM+FAM (p<0.9753).

     

Brown et al. (2005)
USA
RCT
PEDro=5
N=20

 

Population: TBI; Mean Age=40.2yr; Gender: Male=14, Female=6; Mean Time Post Injury=15.8yr.
Intervention: Patients received either body weight support treadmill training (BWSTT; n=10) or conventional over-ground gait training (COGT; n=9) for 15 min plus 30 min of exercise 2 d/wk for 3mo.
Outcome Measure: Functional Ambulation Category, Functional Reach, Timed Up and Go, Gait velocity, Stride Width, and Left-Right Step Length differential.

 

  1. Step Length Differential improved significantly more for the COGT group than for the BWSTT group after 3mo of intervention (p=0.011).  
  2. There were no other significant differences between groups at baseline or after 3mo of intervention on any of the outcome measures.

     

PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al. 2002).