Body Weight Supported Treadmill Training

Evidence Reviewed as of before: 23-11-2010
Author(s): Angela Kim, BSc; Adam Kagan, BSc; Anita Menon MSc. erg; Dr. Robert Teasell; Sanjit Bhogal MSc; Norine Foley BSc; Mark Speechley; Chelsea Hellings; Dr. Nicol Korner-Bitensky; Geoffroy Hubert BSc; Geoffroy Hubert BSc. Lic. K
Patient/Family Information Table of contents

Introduction

Restoring walking ability is one of the primary goals of stroke rehabilitation. Failure to walk following a stroke can lead to serious long-term disability. About one-third of individuals surviving an acute stroke 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.

Body Weight Supported Treadmill

Why use body weight supported treadmill training after a stroke?

Some people have difficulty walking after a stroke. 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 stroke, 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 stroke. The benefits are less certain for individuals who only have mild difficulty walking after a stroke.

  • 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 stroke 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 therapist. 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 gait has been seriously affected by a stroke, 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 (RCT) 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 gait recovery of patients, 8 were fair quality, and 2 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 gait therapy on functional ambulation and other gait 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 gait 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 gait trainers (the “gait trainer” involves a harness-secured patient putting his feet on 2 motorized footplates that simulate stance and swing movements of gait) are presented in the module entitled “Gait 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

Balance
Not Effective
1B

Results from one high quality RCT (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 stroke who received BWS treadmill training or over-ground gait therapy, in addition to their usual therapy.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training does not improve balance during ambulation for acute patients post-stroke.

Endurance
Not Effective
2A

One fair quality RCT (da Cunha IT Jr et al. 2001) involving patients with acute stroke, reported no significant differences in endurance at post-treatment for those who received BWS treadmill training versus over-ground gait therapy – both in addition to usual physical therapy.

Conclusion: There is limited evidence (level 2a) from one fair quality RCT that BWS treadmill training does not improve endurance in patients with an acute stroke.

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 stroke receiving either BWS treadmill training or over-ground gait therapy in addition to their usual therapy, have reported no significant differences in functional ambulation between the two groups at post-treatment, as measured by the Functional Ambulation 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 RCT and one fair quality RCT that BWS treadmill training does not improve functional ambulation in patients with an acute stroke.

Functional independence
Not Effective
1B

Results from one high quality RCT (Nilsson et al. 2001) reported no significant difference in activities 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 gait therapy.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training does not improve functional independence in acute stroke.

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 stroke who received BWS treadmill training as compared to over-ground gait therapy.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training does not improve motor recovery in patients with an acute stroke

Walking speed
Not Effective
1B

Results from one high quality RCT (Nilsson et al. 2001) and one fair quality RCT (da Cunha IT Jr et al. 2001) reported no significant difference in walking speed at post-treatment between acute patients with stroke who received BWS treadmill training or over-ground gait therapy. Only 12 subjects were studied by da Cunha IT Jr et al.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT and one fair quality RCT that BWS treadmill training does not improve walking speed in patients with an acute stroke.

Subacute Phase of Stroke Recovery - Low Ambulatory Status

Balance
Effective
1b

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 is better than overground walking for improving balance in patients with subacute stroke 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 stroke. 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 RCT that BWS treadmill training improves the number of patients discharged to their home environments, compared to assisted overground walking in patients with subacute stroke 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 ambulation in patients with subacute stroke.

The high quality RCT (Franceschini et al., 2009) randomized patients with sub-acute stroke to an intervention group that received BWS treadmill training or a control group that received overground gait training. No significant difference in functional ambulation (as measured by the Functional Ambulation 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 RCT that BWS treadmill training is not more effective than overground gait training in improving functional ambulation in patients with sub-acute stroke.

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 stroke.

One high quality RCT (Franceschini et al., 2009) randomized patients with sub-acute stroke to an intervention group that received BWS treadmill training or a control group that received overground gait 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 RCT that BWS treadmill training is not more effective than overground gait training in improving functional independence in patients with sub-acute stroke.

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 gait training on motor recovery in patients with sub-acute 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 sub-acute 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 sub-acute 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 sub-acute 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 1: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training is not more effective than overground gait training in improving motor recovery in patients with sub-acute stroke and low ambulatory status.

Conclusion 2: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training is more effective than treadmill training without BWS in improving motor recovery in patients with sub-acute stroke and low ambulatory status.

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 participation in patients with low ambulatory status and sub-acute stroke. 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 participation (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 participation in patients with subacute stroke 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 stroke.

The first high quality RCT (Franceschini et al., 2009) randomized patients with sub-acute stroke 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 RCT that BWS treadmill training is not more effective than overground gait training in improving trunk control in patients with sub-acute 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 stroke.

The first high quality RCT (Franceschini et al., 2009) randomized patients with subacute stroke and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gait 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 RCT (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 stroke and low ambulatory status. While one high quality RCT reported no significant difference between BWS treadmill training and overground gait training, another high quality RCT found BWS was more effective than overground walking training in improving walking endurance in patients with sub-acute stroke.

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 stroke.

The first high quality RCT (Franceschini et al., 2009) randomized patients with subacute stroke and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gait 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 RCT (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 gait training) in patients with sub acute stroke and low ambulatory status.

NOTE: One high quality RCT 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 RCT (Franceschini et al., 2009) randomized patients with sub-acute stroke and low ambulatory status to an intervention group that received BWS treadmill training or a control group that received overground gait 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 stroke 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 RCT (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 1: There is strong evidence (level 1a) from two high quality RCTs that BWS treadmill training is not more effective than overground gait training in improving walking speed in patients with sub-acute stroke and low ambulatory status.

Conclusion 2: There is moderate evidence (level 1b) from one high quality RCT that BWS treadmill training is more effective than treadmill training without BWS in improving walking speed in patients with sub-acute stroke and low ambulatory status.

Subacute Phase of Stroke Recovery - High Ambulatory Status

Balance
Not Effective
1B

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 stroke 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 sub-acute 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 sub-acute 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 sub-acute 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 sub-acute 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 RCT that BWS treadmill training is not more effective than treadmill training without BWS for improving motor recovery in patients with sub-acute stroke 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 stroke 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 RCT (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 RCT and one fair quality RCT 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 sub-acute stroke 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 stroke 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. VO2 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 stroke: the MOBILISE trial. Stroke, 41, 1237-1242.

Barbeau H., & Visintin, M. (2003). Optimal outcomes obtained with body-weight support combined with treadmill training in stroke 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). Gait outcomes after acute stroke 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 stroke 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 stroke 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 stroke: What does treadmill training with body weight support add to overground gait training in patients early after stroke? Stroke, 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. Stroke, 26(6), 976-981.

Kosak M. C., & Reding, M. J. (2000). Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. 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 gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow-up. Stroke. 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 stroke: 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 gait in stroke patients through body weight support and treadmill stimulation. Stroke, 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 gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Stroke, 33(12), 2895-2901.

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