By, Matthew Klock DPT
As therapists we are always looking to improve the quality of life for our patients. No matter what setting we practice in, our goal is to improve function so that our patients are able to do more with less support when they are no longer in our care.
I think most people would agree with that. So there’s the start: let’s get our patients better. The next question: how? Here is where we usually start to disagree. Now we know that our treatment strategy should never be cookie-cutter and will depend on the individual patient, their impairments, and their goals but let’s narrow the scope and focus now on patients who require assistance with functional mobility and gait.
One of the best ways to keep a patient safe during gait training and therapists safe from harm is by the use of body-weight support systems. There is a lot of evidence out there to support the use of body-weight support whether it be dynamic or static systems. There is not however, much research looking into how these systems are used and this is what I have found interesting.
Body-weight support (BWS) systems are typically used with two training surfaces: positioned over a treadmill or used over ground. If you are a therapist and looking to get the best outcomes for your patient, which one would you choose? I have thought about this many times and just came across a very interesting article which was published in May of this year.
Researchers in Sao Paulo, Brazil looked at participants’ stride-length, gait speed, step-length, and stance and double-limb support duration when using BWS systems over ground and over a treadmill. They also examined the gait changes while using different levels of support in both groups. Participants who ambulated with BWS positioned over a treadmill demonstrated shorted and slower strides and shorted steps when compared to the group who ambulated over the ground at all levels of body-weight support.
Interestingly, participants who ambulated with BWS over ground exhibited greater variability when they walked than did participants who ambulated on the treadmill. This finding is significant because as the researchers put it, “these (findings) suggest that walking over the ground with BWS allows more interaction among the degrees of freedom of body segments. In terms of functionality, variability during gait practice is desirable and necessary for adaptability” (Barela, Gama, Russo-Junior, Celestino, & Barela, 2019). The increases in variability during practice whether it is during gait training or other functional mobility can help prepare our patients for what they will face outside of the structured treatment setting.
Lastly, the study concluded that participants who ambulated over ground showed a lower rate of change in stance duration than they did on the treadmill. The lower the rate of change, the easier it is to generalize the treatment setting to tasks of daily life. Researchers stated that “walking over the ground with a BWS would promote better and more generalizable practice for individuals seeking to improve their walking capabilities in a clustered environment” (Barela, Gama, Russo-Junior, Celestino, & Barela, 2019). This is extremely important since our goal as therapists is to improve the quality of life for our patients after they leave our care.
More research is needed when looking at gait training over different surfaces but this research is extremely eye-opening. When we have the ability to gait train our patients with body-weight support we should look to do it over a surface which they will be ambulating on when they leave our care. Apart from the findings of the study, gait training over the ground with BWS allows more variation in treatment and can allow us to challenge our patients in ways that treadmill training just cannot match.
Barela, A. M. F., Gama, G. L., Russo-Junior, D. V., Celestino, M. L., & Barela, J. A. (2019). Gait alterations during walking with partial body weight supported on a treadmill and over the ground. Scientific Reports, 9(1). doi: 10.1038/s41598-019-44652-y