There is increasing recognition of the effectiveness of body weight-supported (BWS) walkers for stroke patients with hemiplegia. However, it is unclear whether the effectiveness of BWS walkers is because of the walker alone or the combined effect of the walker and body weight support.
Objective
We aimed to determine whether there are differences between normal, walker, and BWS walker gaits in patients after cerebral infarction (CI) and intracerebral hemorrhage (ICH).
Methods
Twenty-one stroke patients with hemiplegia underwent trials under three gait conditions: normal, walker, and BWS walker gait. Spatiotemporal parameters and joint kinematics during walking were calculated using a three-dimensional motion analyzer. We further examined differences in effects depending on CI and ICH.
Results
Speed and cadence improved in the walker gait and BWS gait groups compared with the normal gait group. In addition, the percentage of the stance and swing phases was improved in BWS walker gait compared to normal gait. Both patients with CI and those with ICH showed similar trends in gait parameters by BWS Walker.
Conclusions
These results suggest that using a BWS walker improves walking in stroke patients with hemiplegia in terms of gait parameter, and is a useful tool for gait training.
AwaiL.FranzM.EasthopeC. S.ValleryH.CurtA.BolligerM. (2017). Preserved gait kinematics during controlled body unloading. Journal of Neuroengineering and Rehabilitation, 14, 25. https://doi.org/10.1186/s12984-017-0239-9
2.
BernerK.CockcroftJ.LouwQ. (2020). Kinematics and temporospatial parameters during gait from inertial motion capture in adults with and without HIV: A validity and reliability study. BioMedical Engineering OnLine, 19(1), 57. https://doi.org/10.1186/s12938-020-00802-2
3.
ChamberlinM. E.FulwiderB. D.SandersS. L.MedeirosJ. M. (2005). Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(9), 1163–1167. https://doi.org/10.1093/gerona/60.9.1163
4.
DeanJ. C.BowdenM. G.KellyA. L.KautzS. A. (2020). Altered post-stroke propulsion is related to paretic swing phase kinematics. Clinical Biomechanics (Bristol, Avon), 72, 24–30. https://doi.org/10.1016/j.clinbiomech.2019.11.024
5.
DuncanP. W.LaiS. M.KeighleyJ. (2000). Defining post-stroke recovery: Implications for design and interpretation of drug trials. Neuropharmacology, 39, 835–841. https://doi.org/10.1016/S0028-3908(00)00003-4
6.
GamaG. L.CelestinoM. L.BarelaJ. A.BarelaA. M. F. (2019). Gait initiation and partial body weight unloading for functional improvement in post-stroke individuals. Gait Posture, 68, 305–310. https://doi.org/10.1016/j.gaitpost.2018.12.008
7.
HsiaoH. Y.KnarrB. A.HigginsonJ. S.Binder-MacleodS. A. (2015). Mechanisms to increase propulsive force for individuals poststroke. Journal of NeuroEngineering and Rehabilitation, 12, 40. https://doi.org/10.1186/s12984-015-0030-8
8.
HsuA. L.TangP. F.JanM. H. (2003). Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Archives of Physical Medicine and Rehabilitation, 84(8), 1185–1193. https://doi.org/10.1016/S0003-9993(03)00030-3
9.
KawakamiK.TanabeS.OmatsuS.KinoshitaD.HamajiY.TomidaK.KoshisakiH.FujimuraK.KanadaY.SakuraiH. (2024). Impact of intracerebral hemorrhage and cerebral infarction on ADL and outcome in stroke patients: A retrospective cohort study. NeuroRehabilitation, 55(1), 41–49. https//doi.org/10.3233/NRE-240182
10.
Khaleghi TazjiM.Valizadeh Ghale-BeigA.SadeghiH.KoumantakisG. A.ChrysagisN.AbbasiA. (2023). Effects of running-induced fatigue on the trunk-pelvis-hip coordination variability during treadmill running at different speeds. Journal of Musculoskeletal and Neuronal Interactions, 23(2), 189–195.
11.
KimH.KimY. H.KimS. J.ChoiM. T. (2022). Pathological gait clustering in post-stroke patients using motion capture data. Gait Posture, 94, 210–216. https://doi.org/10.1016/j.gaitpost.2022.03.007
12.
KimS. B.LeeK. W.LeeJ. H.LeeS. J.ParkJ. G.ParkJ. W. (2018). Effect of caregiver driven robot-assisted in-ward training in subacute stroke patients: A case series. Annals of Rehabilitation Medicine, 42(2), 195–203. https://doi.org/10.5535/arm.2018.42.2.195
13.
KoshisakiH.NagaiS. (2021). Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients. Journal of Physical Therapy Science, 33(5), 434–438. https://doi.org/10.1589/jpts.33.434
14.
LauK. W.MakM. K. (2011). Speed-dependent treadmill training is effective to improve gait and balance performance in patients with sub-acute stroke. Journal of Rehabilitation Medicine, 43(8), 709–713. https://doi.org/10.2340/16501977-0838
MaoY.ChenP.LiL.LiL.HuangD. (2015). Changes of pelvis control with subacute stroke: A comparison of body-weight- support treadmill training coupled virtual reality system and over-ground training. Technology and Health Care: Official Journal of the European Society for Engineering and Medicine, 23(Suppl 2), 355–364. https://doi.org/10.3233/THC-150972
17.
MatsuzawaY.MiyazakiT.TakeshitaY.HigashiN.HayashiH.ArakiS.NakatsujiS.FukunagaS.KawadaM.KiyamaR. (2021). Effect of leg extension angle on knee flexion angle during swing phase in post-stroke gait. Medicina, 57(11), 1222. https://doi.org/10.3390/medicina57111222
18.
McGrathR. L.ZieglerM. L.Pires-FernandesM.KnarrB. A.HigginsonJ. S.SergiF. (2019). The effect of stride length on lower extremity joint kinetics at various gait speeds. PLoS One, 14, e0200862. https://doi.org/101371/journal.pone.0200862
19.
MillerE. W.QuinnM. E.SeddonP. G. (2002). Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke. Physical Therapy, 82(1), 53–61. https://doi.org/10.1093/ptj/82.1.53
20.
MorottiA.GoldsteinJ. N. (2016). Diagnosis and management of acute intracerebral hemorrhage. Emergency Medicine Clinics of North America, 34, 883–889. https://doi.org/10.1016/j.emc.2016.06.010
21.
PohlM.MehrholzJ.RitschelC.RückriemS. (2002). Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: A randomized controlled trial. Stroke, 33(2), 553–558. https://doi.org/10.1161/hs0202.102365
22.
SchmidA.DuncanP. W.StudenskiS.LaiS. M.RichardsL.PereraS.WuS. S. (2007). Improvements in speed-based gait classifications are meaningful. Stroke, 38(7), 2096–2100. https://doi.org/10.1161/STROKEAHA.106.475921
23.
SullivanK. J.KnowltonB. J.DobkinB. H. (2002). Step training with body weight support: Effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Archives of Physical Medicine and Rehabilitation, 83(5), 683–691. https://doi.org/10.1053/apmr.2002.32488
24.
TatsunoH.HamaguchiT.SasanumaJ.KakitaK.OkamotoT.ShimizuM.NakayaN.AboM. (2021). Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction? : A retrospective cohort study. Medicine (Baltimore), 100, e262339. https://doi.org/10.1097/MD.0000000000026339
25.
TomidaK.OhtsukaK.TeranishiT.OgawaH.TakaiM.SuzukiA.KawakamiK.SonodaS. (2022). Effects of change in walking speed on time-distance parameters in post-stroke hemiplegic gait. Fujita Medical Journal, 8(4), 121–126. https://doi.org/10.20407/fmj.2021-016
26.
VerheydenG.NieuwboerA.De WitL.ThijsV.DobbelaereJ.DevosH.De WeerdtW. (2008). Time course of trunk, arm, leg, and functional recovery after ischemic stroke. Neurorehabil Neural Repair, 22, 173–179. https://doi.org/10.1177/1545968307305456
27.
WadaY.KondoI.SonodaS.MiyasakaH.TeranishiT.NagaiS.SaitohE. (2010). Preliminary trial to increase gait velocity with high speed treadmill training for patients with hemiplegia. American Journal of Physical Medicine and Rehabilitation, 89(8), 683–687. https://doi.org/10.1097/PHM.0b013e3181e29d27
28.
YaoJ.GuoN.XiaoY.LiZ.LiY.PuF.FanY. (2019). Lower limb joint motion and muscle force in treadmill and over-ground exercise. BioMedical Engineering OnLine, 18(1), 89. https://doi.org/10.1186/s12938-019-0708-4
29.
ZhuL. L.LindenbergR.AlexanderM. P.SchlaugG. (2010). Lesion load of the corticospinal tract predicts motor impairment in chronic stroke. Stroke, 41, 910–915. https://doi.org/10.1161/STROKEAHA.109.577023
