Posts Tagged treadmill

[ARTICLE] The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View – Full Text

Abstract

To date, rehabilitation robotics has come a long way effectively aiding the rehabilitation process of the patients suffering from paraplegia or hemiplegia due to spinal cord injury (SCI) or stroke respectively, through partial or even full functional recovery of the affected limb. The increased therapeutic outcome primarily results from a combination of increased patient independence and as well as reduced physical burden on the therapist. Especially for the case of gait rehabilitation following SCI or stroke, the rehab robots have the potential to significantly increase the independence of the patient during the rehabilitation process without the patient’s safety being compromised. An intensive gait-oriented rehabilitation therapy is often effective irrespective of the type of rehabilitation paradigm. However, eventually overground gait training, in comparison with body-weight supported treadmill training (BWSTT), has the potential of higher therapeutic outcome due its associated biomechanics being very close to that of the natural gait. Recognizing the apparent superiority of the overground gait training paradigms, a through literature survey on all the major overground robotic gait rehabilitation approaches was carried out and is presented in this paper. The survey includes an in-depth comparative study amongst these robotic approaches in terms of gait rehabilitation efficacy.

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Source: The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View

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[WEB SITE] Gait Trainer™ 3 – Biodex

More than just a treadmill…It is the most important improvement to gait training since the parallel bars.

The Gait Trainer 3 provides audio and visual biofeedback of step length and step speed

The Biodex Gait Trainer™ 3 is more than a treadmill. It is designed with an instrumented deck that issues both audio and visual real-time biofeedback to prompt patients into their correct gait pattern. Step length, step speed and right-to-left time distribution (step symmetry) are directly addressed; patient footfall is compared to desired footfall step after step, both on the display in real time and documented in an easy to read histogram.

The Biodex Gait Trainer is quiet, non-intimidating and allows the therapist to get in there and treat their patients. Real goals are monitored and progress reported. Objective documentation, with comparison to age- and gender-based normative data, helps prove need and document outcomes to family, referring physicians and insurance providers.

The Biodex Gait Trainer 3, with or without the Unweighing System or FreeStep for BWSTT, is suitable for all rehabilitation pathologies. Biodex has recently published Body Weight Support Treadmill Training (BWSTT) with Transition to Over Ground Ambulation: A Clinical Guideline for the Treatment of Patients with Neurological Conditions using Biodex Unweighing System and Gait Trainer. The document classifies the neurologically involved patient, then steps the user through the various phases of recovery for profound,moderate and minimal neurological impairments.

Treadmill Plus… The Gait Trainer 3 also serves as a traditional treadmill, with all the features and benefits of the Biodex RTM600 Rehabilitation Treadmill.

Gait Training SystemGAIT TRAINER 3 + UNWEIGHING
The Biodex Gait Training System

The Gait Trainer provides audio and visual biofeedback of step length and step speed. The Unweighing Support System provides assistance, helping patients regain their confidence, their strength and their stride. The Unweighing System, combined with the Gait Trainer 3 allows every patient the opportunity to get an early start on rehabilitation.

Source: Gait Trainer™ 3 – Treadmills – Physical Medicine | Biodex

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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study

Abstract

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.

Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.

Setting: Outpatient physical therapy clinic.

Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.

Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.

Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.

Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

Source: Constraining movement reveals motor capability in chronic stroke: An initial study

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Chapter 9

Mobility and the Lower Extremity

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

For evidence tables, please click here.

Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study

Abstract

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.

Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.

Setting: Outpatient physical therapy clinic.

Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.

Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.

Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.

Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

 

Source: Constraining movement reveals motor capability in chronic stroke: An initial study

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[Abstract] High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial.  – Europe PMC

Stroke is a major cause of death and long-term disability across the globe. Previous studies have demonstrated the trainability of stroke survivors and documented beneficial effects of aerobic exercises on cardiovascular fitness and gait ability.
The main aim of this study was to compare the effects of a high-intensity treadmill training (HITT) against low-intensity treadmill training (LITT) on gait ability, quality of life, cardiorespiratory fitness and cost of walking in chronic stroke subjects.
Randomized, controlled pilot study.Patients were recruited among Neurorehabilitation Unit outpatient.The sample was composed of 16 subjects suffering from chronic stroke. Subjects were enrolled and randomly allocated either in the HITT (n=8) or in the LITT (n=8). Both groups performed 3-month training, 3 times per week. Subjects were evaluated before starting the training and after the end of the training by mean of clinical scales (Six Minute Walk Test, Ten Meter Walk Test, Health Survey Questionnaire SF-36, Stroke Impact Scale) and instrumental tests (Gait analysis, V02peak and Walking Energy Cost).Fifteen subjects completed the study and no dropouts were observed. One patient in the LITT refused to initiate the training. The HITT group produced greater improvements than LITT group on the Six Minute Walk Test (HITT: 644 meters, LITT: 6 meters; p=0.005) and Ten Meter Walk Test performances (HITT: -1,7 seconds, LITT: 0,6 seconds; p=0.007), stride length (HITT: 3,3 centimetres, LITT: 0,4 centimetres, p=0.003), step length non-paretic side (HITT: 0,5 centimetres, LITT: 2,4 centimetres, p=0.008), step length paretic side (HITT: 1,8 centimetres, LITT: 0,7 centimetres, p=0.004), cadence (HITT: 1,6 step/minute, LITT: 0,6 step/minute, p=0.021) and symmetry ratio (HITT: 0,04, LITT: 0,01, p=0.004), V02peak (HITT: 4,6 ml/kg/min, LITT: 0,87 ml/kg/min; p=0.015) and Walking Energy Cost at 100% of self-selected speed (HITT: -30,8 ml/kg*km, LITT: -20,5 ml/kg*km; p=0.021). Significant changes were found on Six Minute Walk Test (p=0.012) and Ten Meter Walk Test (p=0.042) performances, spatio-temporal gait parameters (stride length p=0.011, step length paretic side p=0.012, cadence p=0.037 and symmetry ratio p=0.012), VO2peak (p=0.025) and cost of walking at 100% of self-selected speed (p=0.018) in the HITT group. In the LITT no significant results were observed.
HITT could be considered a feasible training and led to improvement in gait ability and enhanced VO2peak and reduction in cost of walking compared to LITT. Chronic stroke survivors should be encouraged to engage regular aerobic treadmill training at medium/high intensity. HITT is safe and feasible and has positive effects on gait ability, cardiovascular fitness and cost of walking in subjects with stroke in chronic phase.
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Source: High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke… – Abstract – Europe PMC

 

 

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[Clinical Study] Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke. – Full Text

Abstract

Rhythmic arm and leg (A&L) movements share common elements of neural control. The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. The purpose of this study was to test the efficacy of A&L cycling training as a modality to improve locomotor function after stroke. Nineteen chronic stroke (>six months) participants were recruited and performed 30 minutes of A&L cycling training three times a week for five weeks. Changes in walking function were assessed with (1) clinical tests; (2) strength during isometric contractions; and (3) treadmill walking performance and cutaneous reflex modulation. A multiple baseline (3 pretests) within-subject control design was used. Data show that A&L cycling training improved clinical walking status increased strength by ~25%, improved modulation of muscle activity by ~25%, increased range of motion by ~20%, decreased stride duration, increased frequency, and improved modulation of cutaneous reflexes during treadmill walking. On most variables, the majority of participants showed a significant improvement in walking ability. These results suggest that exploiting arm and leg connections with A&L cycling training, an accessible and cost-effective training modality, could be used to improve walking ability after stroke.

1. Introduction

Body weight supported treadmill training therapy can be used for the recovery of walking after neurological damage. In this rehabilitation paradigm, participants walk on a motorized treadmill with a harness system allowing the weakened leg muscles to be freed from the necessity of body weight support and stepping is performed with the help of robotic interfaces or therapists. This protocol was initially utilized after spinal cord injury and may be equally beneficial for recovery of walking after stroke [15].

Results from this therapy are positive, but there are significant limitations that limit access for the broader stroke population. Body weight supported treadmill training therapy has significant labour requirements, requires specialized equipment, and is typically only available in restricted environments such as in rehabilitation centers [6, 7]. In addition, body weight supported treadmill training offers no additional benefit over conventional physical therapy, as demonstrated in a large randomized clinical trial [2]. A more cost-effective and generally accessible protocol based upon a device (e.g., arm and leg ergometer or a recumbent stepper) that could be more readily used in therapy would be of great benefit where less training is required for physical therapists to supervise training and participants may be more likely to comply with a community-based training regimen [2, 8].

In addition to finding a rehabilitation program that is widely accessible, exploiting the neural and mechanical linkages between the arms and legs that are inherent parts of human locomotion could enhance the recovery of walking [6, 9, 10]. Therefore, incorporating rhythmic arm movement paradigms for locomotor rehabilitation, such as with arm and leg (A&L) cycling, could be very beneficial to stroke locomotor recovery. Although there are differences in kinematics, balance requirements, and loading of the arms between walking and A&L cycling, this type of training activates similar neural networks that are engaged during walking [11]. We have recently shown that, even following a stroke, neural commonalities between A&L cycling and walking persist, despite altered descending supraspinal input from the stroke lesion [12]. Given that A&L cycling and walking share common neural elements and that this persists following stroke, there is a reasonable basis for expectation of training transfer to improve walking.

The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. Thus, the objective of this project was to test the efficacy of A&L cycling training to enhance walking after stroke. Given that A&L cycling and walking share a common core of subcortical regulation, we hypothesize that A&L cycling training will transfer to an improvement in walking. Improvements in walking function were gauged by changes in clinical walking status, strength, and walking performance. If indirect training with A&L cycling does improve walking function, this adjunct therapy could be used as an additional modality to improve walking ability after stroke.

Continue —> Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke

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[ARTICLE] Effects of task-oriented treadmill-walking training on walking ability of stoke patients

Abstract

Background: Generally, treadmill-walking training focuses on weight bearing and the speed of walking. However, changes in direction, speed, and slope while walking require adaptation.

Objective: The effects of task-oriented treadmill-walking training (TOTWT) on the walking ability of stroke patients were evaluated.

Methods: Subjects were randomly divided into two groups: the task-oriented treadmill-walking training (TOTWT) group and the conventional treadmill-walking training (CTWT) group. Evaluation was performed before the commencement of the training and again 4 and 8 wk after training was initiated. The OptoGait system measured gait parameters. The Timed Up and Go test and 6-min walk test were also performed.

Results: Within each group, both the TOTWT and the CTWT groups significantly differed before and after the intervention in all tests (P <  0.05); the CTWT group showed greater improvement in all tests following TOTWT (P <  0.05).

Conclusion: TOTWT improves gait and rehabilitation in the stroke-affected limb, and also improves general gait characteristics.

via Effects of task-oriented treadmill-walking training on walking ability of stoke patients: Topics in Stroke Rehabilitation: Vol 0, No 0.

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Abstract

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995). In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

Get Full Text PDF

via Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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[ARTICLE] Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. – Full Text

…This paper systematically reviews common gait training strategies (neurodevelopmental techniques, muscle strengthening, treadmill training, intensive mobility exercises) to improve walking ability. The results (descriptive summaries as well as pooled effect sizes) from randomized controlled trials are presented and implications for optimal gait training strategies are discussed. Novel and emerging gait training strategies are highlighted and research directions proposed to enable the optimal recovery and maintenance of walking ability…

via Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence.

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