In the United States, someone has a stroke every 40 seconds.1 With stroke mortality decreasing, and more people surviving the acute stroke event, stroke is a leading cause of long-term disability in this country.1,2 The resultant immobility and loss of independent functioning in daily activities speaks to the need for comprehensive and intensive stroke rehabilitation that address the often lasting effects of the stroke.
According to the American Heart Association/American Stroke Association, stroke is not just an acute event, but a chronic condition, with rehabilitation requiring “a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others.”3 These stroke rehabilitation guidelines call for programs to include individually designed plans, retraining to improve abilities to perform daily tasks and improve mobility, balance training to improve balance and decrease the risk of falls, and other key components that address impairments in speech, vision, and cognition, among others.3
In order to maximize the potential for recovery, stroke rehabilitation programs should include intensive, repetitive, meaningful, and task-specific therapies.3 These therapies address the devastating effects of stroke—loss of mobility, decreased ambulation, loss of upper extremity function—all of which impact overall and long-term health and quality of life. At Burke Rehabilitation Hospital, White Plains, NY, more than 500 patients who have suffered a stroke are admitted annually for comprehensive, acute inpatient rehabilitation. The large multidisciplinary team is focused on improving functional independence in preparation for discharge and return home. Individual care plans are developed and often utilize the latest technologies to ensure patient access to the most advanced equipment and evidence-based interventions. Investments in rehabilitation technologies have assisted in providing optimal, state-of-the-art rehab care for patients.
GAITRite/CIR Systems Inc
Gait retraining is one of the primary goals of stroke rehabilitation. Patients often state their goal in rehab is “to walk again.” Many technologies are utilized to support the task-specific and impairment-focused interventions that facilitate pre-gait and ambulation tasks. Each offers unique features and benefits that assist patients and therapists with carrying out each individual’s treatment plan.
The ZeroG Lite from Aretech, Ashburn, Va, is a body-weight support treadmill system that allows patients to safely practice gait training tasks over a treadmill by altering the amount of body-weight support. The difficulty and challenge of the task can be adjusted for the patient’s ability to practice intensive gait and balance activities, and parameters can be changed to change the intensity and duration of the tasks. The treadmill can be inclined and the belt speed can be reversed to facilitate walking up and down slopes.
The Guldmann Active Trainer with Ceiling Mounted Track from Guldmann Inc, Tampa, Fla, is a ceiling track-mounted system that provides adjustable body weight support that is used to provide balance and gait training. Patients with lateropulsion (turning of gait to one side) can safety be brought to a supported upright position to assist with regaining midline orientation and improving posture and weight bearing. Patients who are ambulatory are able to use the trainer in therapy to decrease gait deviations and improve gait quality and speed. Other types of ceiling-mounted body weight support systems that can provide utility for rehabbing individuals affected by stroke include the ZeroG Gait and Balance Training System, also from Aretech. This system can help protect users from falls as well as facilitate functional activities such as walking, sit-to-stand, postural tasks, balance activities, and more. It is also built to accommodate users who weigh up to 400 pounds.
The Bioness Vector from Valencia, Calif-based Bioness is also a ceiling-mounted body-weight support system that can provide a safe environment for over-ground training. The system has an adjustable fall limit setting, and the overhead track designs can be built to a clinic’s specifications. The SafeGait 360° Balance and Mobility Trainer from Gorbel Inc-Medical Division, Fishers, NY, is another overhead track system built to provide dynamic body-weight support and fall protection for early rehab post-stroke.
Other technologies that provide body-weight support for rehab training include LiteGait from Mobility Research, Tempe, Ariz, a gait training device that controls weight bearing, posture, and balance over a treadmill or over ground. It allows individuals to comfortably walk in a secure environment free of falls, altering weight bearing capacity via a sling support. LiteGait provides proper posture, reduces weight bearing, eliminates concerns for balance, and facilitates the training of coordinated lower extremity movement. The device can retrain postural stability and upright posture.
The Lokomat is a robotic device from Hocoma USA, Norwell, Mass, designed to provide highly repetitive physiological gait training that can be useful to therapists treating patients affected by neurological impairment. The user is supported by a harness suspended overhead while using an individually adjustable exoskeleton. Speed, loading, and robotic support all can be adjusted.
The WalkAide System from Innovative Neurotronics, Reno, Nev, is a myo-orthotic device, which combines electrical stimulation with orthotic technology in the treatment of foot drop. It is used to improve independence, functional mobility, and safety.
Also utilized is the NESS L300 Plus Foot Drop System available from Bioness, a neuro-orthotic and rehabilitation system that provides electrical currents to stimulate nerves and muscles to assist with a more natural walking pattern, reduce muscle spasms, reduce muscle loss, maintain or improve range of motion, and increase local blood circulation. It, too, is used to improve independence, functional mobility, and safety in the treatment of foot drop.
The Up n’ Go, offered by Easy Walking, Maple Glen, Pa, is a support device with a suspension system that allows for gait training through partial weight bearing and assists with sit to stand transitions. The device is lightweight and adjustable, allowing use with individuals with a range of balance and strength capabilities…