Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support

Abstract

Objectives: To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Design: Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Setting: Motion analysis laboratory of a rehabilitation centre. Subjects: Fourteen chronic, nonambulatory hemiparetic patients. Intervention: Complex gait analysis while training on the gait trainer and while walking on the treadmill. Main outcome measures: Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Results: Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking ( p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer ( p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing ( p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device. Conclusion: The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.