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BWS

Locomotor training using body weight support (BWS) and motorized treadmill training (TT) can help patients with neurological disorders regain walking ability through task-oriented training and neuroplasticity. BWS systems reduce mechanical demands on muscles and allow for improved coordination, while dynamic systems adapt to trunk movements, enhancing gait rehabilitation. Overground walking provides additional therapeutic benefits compared to treadmill walking, allowing for more natural movement and obstacle navigation.

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Ajas Km
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14 views3 pages

BWS

Locomotor training using body weight support (BWS) and motorized treadmill training (TT) can help patients with neurological disorders regain walking ability through task-oriented training and neuroplasticity. BWS systems reduce mechanical demands on muscles and allow for improved coordination, while dynamic systems adapt to trunk movements, enhancing gait rehabilitation. Overground walking provides additional therapeutic benefits compared to treadmill walking, allowing for more natural movement and obstacle navigation.

Uploaded by

Ajas Km
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Locomotor Training using Body Weight Support and

Motorized Treadmill Training

 While locomotor control is distributed across discrete regions of the CNS, walking is
primarily a brainstem and spinal cord function. For example, locomotor central
pattern generators (CPGs) have been identified as existing in the ventral spinal cord
while integrating command centers have been identified in the medial medullary
reticular formation. Thus, patients with cortical stroke may be able to regain the
ability to walk. The CNS is responsive to training-induced plastic changes in
locomotor function and recovery. Thus, patients with limited recovery who lack
voluntary isolated control can still be trained to walk. Although sensation is normally
used for walking, patients can also learn to walk with limited sensation.

(Walking is mostly controlled by the brainstem and spinal cord, not just the brain. In
fact:Special nerve networks in the spinal cord (called central pattern generators or CPGs)
help create the rhythm of walking.

The medulla (part of the brainstem) helps send movement commands.

So, even if someone has had a stroke in the brain (cortex), they may still be able to learn
to walk again.

Why? Because the nervous system can adapt and reorganize itself with training—a process
called neuroplasticity.

Also, Even if someone can’t move their leg muscles on their own, they can still be trained
to walk using special techniques.

And even if they have reduced sensation, they can still learn to walk with practice.)

 Body weight support (BWS) and motorized treadmill training (TT) allows the
clinician to improve recovery of walking ability after various neurological disorders
like stroke,spinalcord injuries,TBIs etc using intensive task oriented training.
 Normal kinematics and phase relationships of the full gait cycle are promoted,
including limb loading in midstance and unweighting and stepping during swing.
 Initially, manual assistance can be provided by trainers to normalize gait in the
presence of muscle weakness and impaired balance. For example, one therapist
provides manual assistance to foot placement during stepping movements of the
weaker LE while a second therapist stands behind the patient and provides manual
assistance to pelvic rotation movements

 An overhead harness is used to support a portion of the patient’s weight (e.g., 30%
progressing down to 20%, and 10%).
 The harness controls the upright position of the patient in the absence of good postural
stability and reduces fear of falling.
 The use of a harness also eliminates the need for adaptive UE support to compensate
for LE weakness.
 As improvements in walking occur, the harness is removed and full weight-bearing is
allowed.
 At this point, the patient is practicing supervised walking on a treadmill. Initially the
treadmill speeds are slow (e.g., 0.52 mph [0.23 m/sec]) and are gradually increased as
the patient’s walking ability is improved (e.g., 0.95 mph [0.42 m/sec]).
 Progression is to task-specific practice and overground walking.
 . Individual studies have reported improvements in walking speed,
distance,endurance, and walking function.
 Walking with bodyweight support can aid gait rehabilitation and reveal insight into
gait biomechanics and control.
 Providing bodyweight support reduces the mechanical demand on muscles and can
make it easier to coordinate limb motion.
 For patients with limited strength, walking with bodyweight support essentially
increases their strength, making it possible to practice walking.
 Bodyweight support systems typically provide a lifting force via a harness around the
waist, thighs, and often the chest.
 The vertical lifting force counteracts the downward force on the body caused by
gravity.
 These harness-based bodyweight support systems do not alter the weight or inertial
properties of the individual body segments.
 Bodyweight supported gait practice can improve walking ability in people with
Parkinson's, hemiparesis induced by stroke, or incomplete spinal cord injury
 Studies on neurologically intact human subjects have revealed bodyweight support
alters the walk-to-run transition speed, reduces stance time, reduces metabolic cost of
walking, and reduces some leg muscle activity while having no impact on other leg
muscles .

 The trunk has sinusoidal vertical excursion during gait, making it a challenge to
provide a constant support force.
 Static bodyweight support systems do not adapt to changes in trunk height.
 Static bodyweight support systems are relatively simple, but they restrict trunk
movement and thus do not permit normal gait kinematics.
 Many bodyweight support systems are dynamic, in that they allow for vertical
movement of the trunk.
 The fluctuations in support force vary between system designs. Minimizing
fluctuations in support force is challenging and is mostly achieved with active
controlled systems .
 Traditionally most bodyweight support systems used for gait rehabilitation have high
fluctuations in support force across the gait cycle
 Walking with bodyweight support overground has more therapeutic benefits than
walking on a treadmill with bodyweight support, but both have positive effects on
walking ability .
 Overground walking allows the person to traverse over obstacles, around corners,
up/down small stairs, and to choose their own walking speed.
 The majority of bodyweight support systems are limited to treadmill walking, as it
easier to implement a stationary lifting force than a mobile lifting force . Some
patients with limited strength cannot easily takes steps without high levels of
bodyweight support (around 75%) .
 Commercially available overground dynamic bodyweight support systems: the Gorbel
SafeGait 360 Balance and Mobility Trainer, the Bioness Vector, and the Aretech
ZeroG .) These systems are fixed to the ceiling with a track and provide near constant
force to the user. Only one commercially available system has provided data on its
force fluctuations throughout the gait cycle.

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