Introduction
Restoring walking ability is one of the primary goals of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More rehabilitation. Failure to walk following a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More can lead to serious long-term disability. About one-third of individuals surviving an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More are unable to walk three months after being admitted to hospital (Wade et al. 1987). Walking can be affected by residual impairments and disabilities including impaired balance, muscle stiffness, and decreased motor function. One method for retraining walking has been through partial body weight support (BWS) combined with treadmill training. The person is partially suspended in a harness either from the ceiling or from an apparatus frame (see photograph), in order to reduce weight bearing and provide postural support for treadmill walking. The amount of support can be gradually decreased as postural control, balance, and coordination begin to improve.
Patient/Family Information
Author: Marc-André Roy, MSc
What is body weight supported treadmill training?
Body weight supported (BWS) treadmill training is a method for retraining walking. A person using BWS is supported by a harness that is suspended from a metal frame or from the ceiling (see photograph here below). The harness and BWS provide support and reduce the weight on your feet while you walk on the treadmill. The amount of support can be gradually increased or decreased according to your particular needs. For example, if your therapist increases the treadmill speed, you might need more BWS for a short time as you try to keep your balance and posture while walking faster.
Front view of a body weight support system with an overhead suspension and harness that supports the subject on the treadmill.
Why use body weight supported treadmill training after a stroke?
Some people have difficulty walking after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. BWS treadmill training may be a safe way for you to begin walking when you are not able to walk safely by yourself. BWS allows some people to start walking earlier after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, especially if they currently require two people to help them walk over ground. It also allows some people to practice walking when they are not ready to do so over ground.
Does it work for stroke?
The best research studies on BWS and treadmill training have shown differing results depending on the severity of the walking deficit. In general, benefits have been found in people who have serious problems walking after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. The benefits are less certain for individuals who only have mild difficulty walking after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
- For those with serious walking deficits, a number of high quality research studies have shown that BWS treadmill training is more effective than usual walking training for improving speed of walking, endurance, balance, motor recovery, and functional walking.
- For those with mild walking deficits, high quality studies have not found that BWS treadmill training is more effective than usual walking training.
What can I expect?
BWS treadmill training is a fairly new treatment. You may be receiving rehabilitation in a setting that has the equipment and if so, you may be offered this treatment. Many different harnesses have been designed to support the body. However, there are some aspects of this intervention that are common to all the equipment used:
- You will wear a harness over your clothes.
- The harness is then fastened to an overhead suspension system.
- The therapist providing the therapy will decide on how much of your body weight is supported by the harness and how much is supported by your legs.
- When the therapist adjusts the BWS it will feel like you are being lifted slightly off the floor.
- The therapist will then start the treadmill at a very low speed. The therapist can then increase the speed as your walking ability improves.
Side effects/risks?
There are no specific side effects of BWS treadmill training. In fact, research has shown that it is easier on your heart if you walk with your body weight supported – so after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More it may be easier for you to practice walking using BWS as compared to walking over ground.
Generally, people who have used BWS tell us that they feel more confident because they are supported by the harness and can practice walking without the risk of a fall.
However, there are some patients who have told us that they find the harness uncomfortable to wear – and some who do not enjoy walking on a treadmill.
Who provides the treatment?
BWS treadmill training is typically performed by a physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
. An assistant may be present to help you get ready by putting on your harness and staying with you during rest periods. This equipment is quite costly and it is quite a labor-intensive treatment, so the rehabilitation center where you are receiving rehabilitation may not have a BWS system. If further research continues to show benefits for those with severe walking difficulties, it is likely that more rehabilitation centers will purchase the equipment.
How many treatments?
The best exercise program design is unknown. However, in most of the studies that have found BWS treadmill training effective, the patients received the therapy 20 to 40 minutes (with rest periods in-between), 4-to-5 days a week, for at least 2 weeks, and sometimes as long as 6 weeks.
How much does it cost? Does insurance pay for it?
In Canada, BWS treadmill training is covered if you are receiving care in a rehabilitation setting that offers this form of treatment. If you are receiving private rehabilitation you will have to verify that your insurance covers the cost of BWS treadmill training.
Is body weight supported treadmill training for me?
If your gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
has been seriously affected by a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, BWS treadmill training could help you regain endurance, control of your lower limbs, and cardiovascular health. However, further studies are needed to better understand who can benefit most from this type of training.
Clinician Information
Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (level 1a) for an outcome.
Of the 12 studies investigating the effect of BWS treadmill training on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
recovery of patients, eight were fair quality, and two were not scored as they were not RCTs.
A systematic Cochrane review investigating the effectiveness of BWS treadmill training post-stroke concluded that there are no statistically significant differences between patients receiving BWS treadmill training as compared to over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
and other gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters. They did however report that patients who walked independently at baseline showed a trend towards greater improvement than those with more severe impairments (Moseley et al. 2003).
Since that time new studies have found significant post-intervention differences on a number of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters between those who received BWS and those who received treadmill training without BWS.
Only studies that compare BWS treadmill to either overground walking, or treadmill training with no BWS are reviewed in this module. Studies that involve comparisons with electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers (the “electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers” involves a harness-secured patient putting his feet on two motorized footplates that simulate stance and swing movements of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
) are presented in the module entitled “Electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers”.
*Although no significant between-group differences were found, results indicated a potential benefit of using BWS treadmill training compared to other therapies.
Results Table
View results table
Outcomes
Acute Phase of Stroke Recovery
Results from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Nilsson et al. 2001) reported no significant difference in balance at post-treatment and at the 10 month follow-up assessment (as assessed by the Berg Balance Scale) between those with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training or over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy, in addition to their usual therapy.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve balance during ambulation for acute patients post-stroke.
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (da Cunha IT Jr et al. 2001) involving patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More, reported no significant differences in endurance at post-treatment for those who received BWS treadmill training versus over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy – both in addition to usual physical therapy.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve endurance in patients with an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Functional ambulation
Not Effective
1B
One high quality RCT (Nilsson et al. 2001) and one fair quality RCT(da Cunha IT Jr et al. 2001a) involving patients with an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More receiving either BWS treadmill training or over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy in addition to their usual therapy, have reported no significant differences in functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
between the two groups at post-treatment, as measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Categories (FAC). In addition, the study by (Nilsson et al. 2001) found no significant differences between the two groups on the FAC at 10-month follow-up.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in patients with an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Functional independence
Not Effective
1B
Results from one high quality RCT (Nilsson et al. 2001) reported no significant difference in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living as assessed by the Functional Independence Measure (FIM) at post-treatment and at the 10 month follow-up assessment, between acute patients who received BWS treadmill training versus over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve functional independence in acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Motor recovery
Not Effective
1B
Results from one high quality RCT(Nilsson et al. 2001) reported no significant improvements in motor recovery as assessed by the Fugl-Meyer Motor Assessment (FMA) at post-treatment and at 10 month follow-up, for acute patients with a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training as compared to over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve motor recovery in patients with an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More
Walking speed
Not Effective
1B
Results from one high quality RCT (Nilsson et al. 2001) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (da Cunha IT Jr et al. 2001) reported no significant difference in walking speed at post-treatment between acute patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training or over-ground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
therapy. Only 12 subjects were studied by da Cunha IT Jr et al.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training does not improve walking speed in patients with an acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Subacute Phase of Stroke Recovery - Low Ambulatory Status
One high quality RCT (Visintin et al. 1998) investigated the effect of BWS treadmill training on balance in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. The study found significant between-group differences in balance (as measured by the Berg Balance Scale) at post-treatment in favour of patients who received BWS treadmill training as compared to treadmill training without BWS, but these significant differences were not seen at the 3 month follow-up. Further sub-analyses of the data (Barbeau and Visintin (2003) suggested significant differences in balance on the Berg Balance Scale at post-treatment and at 3-month follow-up assessment, in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS. Such differences were not observed between patients with high ambulatory status in the two groups at post-treatment and at 3-month follow-up.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is better than overground walking for improving balance in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low initial ambulatory status post-stroke.
Discharge destination
Effective
1B
One high quality RCT (Ada et al. 2010) investigated the effect of BWS treadmill training on discharge destination in patients with low ambulatory status and subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. Within 6 months, the study found a significant between-group difference in the number of patients who were discharged home or in supported accomodation in favour of the group that received up to 6 months* of BWS treadmill training group compared to a control group that received up to 6 months* of assisted overground walking.
* Patients received up to 6 months training, where training ended at discharge or when the patient was able to walk unassisted for 15 meters.
Note: Fewer patients in intervention group required assisted accommodation following discharge.
Conclusion: There is moderate evidence (level 1b) from 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training improves the number of patients discharged to their home environments, compared to assisted overground walking in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status.
Functional ambulation
Not Effective
1B
One high quality RCT (Franceschini et al., 2009) has investigated the effect of BWS treadmill training on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
(as measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Categories) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is not more effective than overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Functional independence
Not Effective
1B
One high quality RCT (Franceschini et al., 2009) investigated the effect of BWS treadmill training on functional independence in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in functional independence (as measured by the Barthel Index) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is not more effective than overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in improving functional independence in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Motor recovery
Conflicting
4
Three high quality RCTs (Franceschini et al., 2009, Werner et al. 2002, Visintin et al. 1998) investigated the effect of BWS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training on motor recovery in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The first high quality RCT (Franceschini et al., 2009) randomized patients with subacute stroke to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in motor recovery (as measured by the Motricity Index) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Werner et al. 2002) investigated patients with a subacute stroke receiving either BWS treadmill training or BWS and “gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer”. The “gait trainer” involves a harness-secured patient putting his feet on 2 motorized footplates that simulate stance and swing movements of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
(both groups also received usual physical therapy). No significant differences were found on the Rivermead Motor Assessment (gross function, trunk and leg subscales) at post-treatment and 6-month follow-up between the two groups of patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status. NOTE: As both groups received BWS this study is not included in determining levels of evidence for BWS in patients with a subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Visintin et al. 1998) indicated significant improvement in motor recovery (as measured by the STREAM- STrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More REhabilitation Assessment of Movement) at post-treatment and at 3-month follow-up assessment, for patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training as compared to treadmill training without BWS.
Further sub-group analyses of the data (Barbeau and Visintin, 2003) indicated significant improvements in motor recovery at post-treatment and at 3-month follow-up assessment, in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS. Such differences were not observed at post-treatment and at 3-month follow-up between groups with high ambulatory status.
Conclusion: There is conflicting evidence (level 4) regarding the effectiveness of BWS treadmill training on motor recovery in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status. While one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More reported no significant difference between BWS treadmill training and overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More found BWS was more effective than overground walking training in improving motor recovery in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Self-rated walking perception and community participation
Not Effective
1B
One high quality RCT (Ada et al. 2010) investigated the effect of BWS treadmill training on community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in patients with low ambulatory status and subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More. At 6 months, no significant between-group differences were found for self-rated walking perception (10 point Likert Scale), self-rated number of falls over 6 months, or community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More (Adelaide Activities Profile) between the group that received up to 6 months* of BWS treadmill training group compared to the group that received up to 6 months* of assisted overground walking.
* Patients received up to 6 months training, where training ended at discharge or when the patient was able to walk unassisted for 15 meters.
Conclusion: There is moderate evidence (level 1b) from 1 high quality RCT that BWS treadmill training does not improve self-rated walking perception and community participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low initial ambulatory status.
Trunk control
Not Effective
1B
One high quality RCT (Franceschini et al., 2009) investigated the effect of BWS treadmill training on trunk control in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More to an intervention group that received BWS treadmill training or a control group that received overground gait training. No significant difference in trunk control (as measured by the Trunk Control Test) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is not more effective than overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in improving trunk control in patients with subacute stroke.
Walking endurance
Conflicting
4
Two high quality RCTs (Franceschini et al., 2009, Dean et al. 2010) examined the effect of BWS treadmill training on walking endurance in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in walking endurance (as measured by the 6-minute Walk Test) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Dean et al. 2010) investigated the effect of BWS treadmill training on walking endurance in patients with low ambulatory status and subacute stroke. The study found a significant difference at 6 months in walking endurance (as measured by the 6-Minute Walking Test) in favour of the group that received BWS treadmill training for up to 6 months* compared to the group that received assisted overground walking training for up to 6 months*.
* Patients received up to 6 months training, where training ended at discharge or when the patient was able to walk unassisted for 15 meters.
Conclusion: There is conflicting evidence (level 4) regarding the effectiveness of BWS treadmill training on walking endurance in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status. While one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More reported no significant difference between BWS treadmill training and overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More found BWS was more effective than overground walking training in improving walking endurance in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Walking independence
Not Effective
1a
Two high quality RCTs (Franceschini et al., 2009, Ada et al. 2010) examined the effect of BWS treadmill training on walking independence in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in walking independence (as measured by the Walking Handicap Scale) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Ada et al. 2010) investigated the effect of BWS treadmill training on walking independence in patients with low ambulation. At 6 months, a non-significant between-group difference was found in the number of patients to reach independent walking, in favor of the group that received up to 6 months* of BWS treadmill training compared to a group that received up to 6 months* of assisted overground walking. The BWS treadmill group achieved independent walking 2 weeks earlier than the control group (median of 5 weeks for BWS vs. 7 weeks for control). However, this between-group difference was not statistically significant.
* Patients received up to 6 months training, where training ended at discharge or when the patient was able to walk unassisted for 15 meters.
Conclusion: There is high evidence (level 1a) from 2 high quality RCTs that BWS treadmill training does not improve walking independence compared to control therapies (assisted overground walking or overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) in patients with sub acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status.
Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More showed clinically important differences in favor of BWS training for the number of patients to achieve independent walking and for time until independent walking.
Walking speed
Conflicting
4
Three high quality RCTs (Franceschini et al., 2009, Visintin et al. 1998, Dean et al. 2010) and one fair quality RCT (Kosak et al. 2000) examined the effect of BWS treadmill training on walking speed in patients with subacute stroke.
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Franceschini et al., 2009) randomized patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference in walking speed (as measured by the 10-meter Walk Test) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
The second high quality RCT (Visintin et al. 1998) indicated significant differences in walking speed at post-treatment and at 3-month follow-up assessment, for patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training as compared to treadmill training without BWS. Further sub-analyses of the data (Barbeau and Visintin, 2003) indicated significant differences in walking speed at post-treatment and at 3-month follow-up assessment in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS, but no differences between groups in those with high ambulatory status.
The third high quality RCT (Dean et al. 2010) found no significant differences at 6 months in walking speed (as measured by the 10 Meter Walking Test) in the group treated for up to 6 months* with BWS treadmill training as compared to the group treated for up to 6 months* with assisted overground walking. All patients in this study had low ambulatory status at baseline.
* Patients received up to 6 months training, where training ended at discharge or when the patient was able to walk unassisted for 15 meters.
The one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Kosak et al. 2000) reported a significant between-group difference in walking speed at post-treatment in favor of patients receiving BWS treadmill training as compared to aggressive bracing assisted overground walking over ground for those with a low ambulatory status. However, no significant between- group differences were found for those with high initial ambulatory status.
Conclusion: There is conflicting evidence (level 4) regarding the effectiveness of BWS treadmill training on walking speed in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and low ambulatory status. While two high quality RCTs reported no significant difference between BWS treadmill training and overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, another high quality RCT found BWS was more effective than overground walking training in improving walking speed in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More.
Subacute Phase of Stroke Recovery - High Ambulatory Status
One high quality RCT (Visintin et al. 1998) investigated the effect of BWS treadmill training on balance in patients with subacute stroke. The study found significant between-group differences in balance (as measured by the Berg Balance Scale) at post-treatment in favour of patients who received BWS treadmill training as compared to treadmill training without BWS, but these significant differences were not seen at the 3 month follow-up. Further sub-analyses of the data (Barbeau and Visintin (2003) suggested significant differences in balance on the Berg Balance Scale at post-treatment and at 3-month follow-up assessment, in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS. Such differences were not observed between patients with high ambulatory status in the two groups at post-treatment and at 3-month follow-up.
Conclusion: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training does not improve balance during ambulation compared to overground walking for patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and high initial ambulatory status.
Motor recovery
Not Effective
1B
Three high quality RCTs (Franceschini et al., 2009, Werner et al. 2002, Visintin et al. 1998) investigated the effect of BWS gait training on motor recovery in patients with subacute stroke.
The first high quality RCT (Franceschini et al., 2009) randomized patients with subacute stroke to an intervention group that received BWS treadmill training or a control group that received overground gait training. No significant difference in motor recovery (as measured by the Motricity Index) was found at 2 weeks (mid-intervention), 4 weeks (post-intervention), 6 weeks (follow-up) or at 6 months post-stroke.
The second high quality RCT (Werner et al. 2002) investigated patients with a subacute stroke receiving either BWS treadmill training or BWS and “gait trainer”. The “gait trainer” involves a harness-secured patient putting his feet on 2 motorized footplates that simulate stance and swing movements of gait (both groups also received usual physical therapy). No significant differences were found on the Rivermead Motor Assessment (gross function, trunk and leg subscales) at post-treatment and 6-month follow-up between the two groups of patients with subacute stroke and low ambulatory status. NOTE: As both groups received BWS this study is not included in determining levels of evidence for BWS in patients with a subacute stroke.
The third high quality RCT (Visintin et al. 1998) indicated significant improvement in motor recovery (as measured by the STREAM- STroke REhabilitation Assessment of Movement) at post-treatment and at 3-month follow-up assessment, for patients with subacute stroke who received BWS treadmill training as compared to treadmill training without BWS.
Further sub-group analyses of the data (Barbeau and Visintin, 2003) indicated significant improvements in motor recovery at post-treatment and at 3-month follow-up assessment, in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS. Such differences were not observed at post-treatment and at 3-month follow-up between groups with high ambulatory status.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is not more effective than treadmill training without BWS for improving motor recovery in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and high ambulatory status.
Walking speed
Not Effective
1B
Results from one high quality RCT (Visintin et al. 1998) indicated significant differences in walking speed at post-treatment and at 3-month follow-up assessment, for patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who received BWS treadmill training as compared to treadmill training without BWS. Further sub-analyses of the data (Barbeau and Visintin, 2003) indicated significant differences in walking speed at post-treatment and at 3-month follow-up assessment in patients with low ambulatory status who received BWS treadmill training as compared to treadmill training without BWS, but no differences between groups in those with high ambulatory status.
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More (Kosak et al. 2000) reported a significant between-group difference in walking speed at post-treatment in favor of patients receiving BWS treadmill training as compared to aggressive bracing assisted overground walking over ground for those with a low ambulatory status. However, no significant between- group differences were found for those with high initial ambulatory status.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. More that BWS treadmill training is not more effective than either treadmill training with no BWS, or assisted over ground walking in improving walking speed in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More and high initial ambulatory status.
Chronic Phase of Stroke Recovery - High Ambulatory Status
Cardiac/respiratory status
Effective
2B
Danielsson et al. 2000 conducted a within-subject study of 18 chronic patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. More who were ambulatory with or without an assistive device. Subjects walked on a treadmill with 0% and 30% BWS at their self-selected maximum walking speed. VO2Blood oxygen level.
and heart rate of patients were lower during walking with 30% BWS as compared to 0% BWS when tested at various walking velocities. Although BWS during treadmill training can decrease the O2 consumption and cardiac output required for the task, the actual cardiac/respiratory status of the client may not be necessarily improved as a result of this intervention.
Conclusion: There is limited evidence (level 2b) from one non-randomized study that body weight supported treadmill training can decrease the O2 consumption and cardiac input required for the task by lowering VO2 and heart rate in ambulatory patients with a chronic stroke.
References
Ada L, Dean CM, Morris M, et al. (2010). Randomised trial of treadmill walking with body weight support to establish walking in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: the MOBILISE trial. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 41, 1237-1242.
Barbeau H., & Visintin, M. (2003). Optimal outcomes obtained with body-weight support combined with treadmill training in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More subjects. Arch Phys Med Rehabil, 84(10), 1458-1465.
da Cunha I. T., Jr., Lim P. A., Qureshy H., Henson H., Monga T., & Protas, E. J. (2002). GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
outcomes after acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Arch Phys Med Rehabil, 83(9), 1258-1265.
Danielsson A., & Sunnerhagen, K. S. (2000). Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More and in healthy subjects. Arch Phys Med Rehabil, 81(7), 953-957.
Dean CM, Ada L, Bampton J, Morris ME, Katrak PH, Potts S. (2010). Treadmill walking with body weight support in subacute non-ambulatory strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More improves walking capacity more than overground walking: a randomised trial. Journal of Physiotherapy, 56, 97–103.
Franceschini M., Carda S., Agosti M., Antenucci R., Malgrati D., & Cisari C (2009). Walking after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: What does treadmill training with body weight support add to overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in patients early after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More? StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 30, 3079-3085.
Hesse S., Bertelt C., Jahnke M. T., Schaffrin A., Baake P., Malezic M., et al. (1995). Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 26(6), 976-981.
Kosak M. C., & Reding, M. J. (2000). Comparison of partial body weight-supported treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training versus aggressive bracing assisted walking post strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. Neurorehabil Neural Repair, 14(1), 13-19.
Ng M.F.W., Tong R.K.Y., & Li, L.S.W. (2008). A pilot study of randomized clinical controlled trial of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients with partial body-weight support electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer and functional electrical stimulation: six-month follow-up. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More. 39(1):154-60
Nilsson L., Carlsson J., Danielsson A., Fugl-Meyer A., Hellstrom K., Kristensen L., et al. (2001). Walking training of patients with hemiparesis at an early stage after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil, 15(5), 515-527.
Visintin M., Barbeau H., Korner-Bitensky N., & Mayo, N. E. (1998). A new approach to retrain gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients through body weight support and treadmill stimulation. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 29(6), 1122-1128.
Werner C., Von Frankenberg S., Treig T., Konrad M., & Hesse, S. (2002). Treadmill training with partial body weight support and an electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer for restoration of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More patients: a randomized crossover study. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More, 33(12), 2895-2901.
