The difference between the effectiveness of body-weight-supported treadmill training combined with functional electrical stimulation and sole body-weight-supported treadmill training for improving gait parameters in stroke patients: A systematic review and meta-analysis

Effects of body weight support training on balance and walking function in stroke patients: a systematic review and meta-analysis

Objective

To comprehensively and quantitatively evaluate the impact of body weight support training (BWST) on balance and gait function in stroke patients based on an evidence-based basis and to identify the most effective intervention strategies.

Methods

PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and Chinese SinoMed Database were searched until November 25, 2023. Quality assessment and meta-analysis were performed using RevMan 5.2 and Stata 14.0 software.

Results

A total of 31 randomized controlled trials involving 1,918 patients were included in the study. The meta-analysis demonstrated that body weight support training (BWST) significantly improved Berg Balance Scale (BBS) scores (MD = 3.60; 95% CI: 1.23 to 5.98; p = 0.003), gait speed (SMD = 0.77; 95% CI: 0.38 to 1.15; p < 0.0001), and step length (SMD = 0.46; 95% CI: 0.19 to 0.72; p = 0.0008) in stroke patients compared to conventional rehabilitation. For enhancing balance function, the most effective interventions were identified as a disease duration of 3-6 months (MD = 5.16; 95% CI: 0.76 to 9.57; p = 0.02), intervention time of 4-8 weeks (MD = 5.70; 95% CI: 2.90 to 8.50; p < 0.0001), a maximum body weight support level above 30% (MD = 3.80; 95% CI: 1.48 to 6.13; p = 0.001), and a maximum training walking speed of 0.2 m/s or more (MD = 4.66; 95% CI: 0.37 to 9.70; p = 0.03). For improving walking function, the optimal interventions were also a disease duration of 3-6 months (gait speed: SMD = 0.59; 95% CI: 0.15 to 1.03; p = 0.008; step length: SMD = 0.27; 95% CI: 0.06 to 0.56; p = 0.04), intervention time of 4-8 weeks (gait speed: SMD = 1.01; 95% CI: 0.44 to 1.59; p = 0.0006; step length: SMD = 0.83; 95% CI: 0.54 to 1.12; p < 0.00001), a maximum body weight support level above 30% (gait speed: SMD = 0.79; 95% CI: 0.36 to 1.22; p = 0.0003; step length: SMD = 0.79; 95% CI: 0.47 to 1.11; p < 0.00001), and a maximum training walking speed of 0.2 m/s or more (gait speed: SMD = 1.26; 95% CI: 0.62 to 1.90; p = 0.0001; step length: SMD = 0.85; 95% CI: 0.38 to 1.31; p = 0.0003).

Conclusion

Compared with conventional rehabilitation training, BWST demonstrates superior efficacy in enhancing balance and walking function in stroke patients, with a consistent optimal intervention strategy. The most effective program includes a disease duration of 3-6 months, an intervention period of 4-8 weeks, a maximum body weight support of 30% or more, and a maximum training walking speed of 0.2 m/s or greater.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022358963.

Gait training with a safety suspension device accelerates the achievement of supervision level walking in subacute stroke: a randomized controlled trial

Practicing walking in a safety suspension device allows patients to move freely and without excessive reliance on a therapist, which requires correcting errors and may facilitate motor learning. This opens the possibility that patients with subacute stroke may improve their walking ability more rapidly. Therefore, we tested the hypothesis that overground gait training in a safety suspension device will result in achieving faster supervision-level walking than gait training without the suspension device. Twenty-seven patients with stroke admitted to the rehabilitation ward with functional ambulation categories (FAC) score of 2 at admission were randomly allocated to safety suspension-device group (SS group) or conventional assisted-gait training group (control group). In addition to regular physical therapy, each group underwent additional gait training for 60 min a day, 5 days a week for 4 weeks. We counted the days until reaching a FAC score of 3 and assessed the probability using Cox regression models. The median days required to reach a FAC score of 3 were 7 days for the SS group and 17.5 days for the control group, which was significantly different between the groups ( P  < 0.05). The SS group had a higher probability of reaching a FAC score of 3 after adjusting for age and admission motor impairment (hazard ratio = 3.61, 95% confidence interval = 1.40-9.33, P  < 0.01). The gait training with a safety suspension device accelerates reaching the supervision-level walking during inpatient rehabilitation. We speculate that a safety suspension device facilitated learning by allowing errors to be experienced and correct in a safe environment.

Effectiveness of Body Weight-Supported Gait Training on Gait and Balance for Motor-Incomplete Spinal Cord Injuries: A Systematic Review with Meta-Analysis

OBJECTIVE

This review aims to analyse the effectiveness of body weight-supported gait training for improving gait and balance in patients with motor-incomplete spinal cord injuries.

METHOD

Relevant articles were systematically searched in electronic databases to identify randomised controlled trials of body weight-supported gait training (either with methods of robotic, manual, and functional electrical stimulation assistance) versus conventional physical therapy or no intervention. Subjects were >16 years-old with motor-incomplete spinal cord injury (AIS C or D). Primary outcomes were gait-related parameters (functionality, endurance, and speed) and balance. Quality of life was included as a secondary outcome. Articles were selected up to 31 December 2023.

RESULTS

Fifteen studies met the inclusion criteria (n = 673). Nine studies used robotic assistance, four trials performed manual assistance, one study functional electrical stimulation assistance, and one trial performed the intervention without guidance. Robot-assisted body weight-supported gait training improved walking functionality (SMD = 1.74, CI 95%: 1.09 to 2.39), walking endurance (MD = 26.59 m, CI 95% = 22.87 to 30.31), and balance (SMD = 0.63, CI 95% = 0.24 to 1.02).

CONCLUSIONS

Body weight-supported gait training is not superior to conventional physiotherapy in gait and balance training in patients with motor-incomplete spinal cord injury. However, body weight-supported gait training with robotic assistance does improve walking functionality, walking endurance, and balance, but not walking speed.

Exploring the Intersection of Geophysics and Diagnostic Imaging in the Health Sciences

To develop diagnostic imaging approaches, this paper emphasizes the transformational potential of merging geophysics with health sciences. Diagnostic imaging technology improvements have transformed the health sciences by enabling earlier and more precise disease identification, individualized therapy, and improved patient care. This review article examines the connection between geophysics and diagnostic imaging in the field of health sciences. Geophysics, which is typically used to explore Earth's subsurface, has provided new uses of its methodology in the medical field, providing innovative solutions to pressing medical problems. The article examines the different geophysical techniques like electrical imaging, seismic imaging, and geophysics and their corresponding imaging techniques used in health sciences like tomography, magnetic resonance imaging, ultrasound imaging, etc. The examination includes the description, similarities, differences, and challenges associated with these techniques and how modified geophysical techniques can be used in imaging methods in health sciences. Examining the progression of each method from geophysics to medical imaging and its contributions to illness diagnosis, treatment planning, and monitoring are highlighted. Also, the utilization of geophysical data analysis techniques like signal processing and inversion techniques in image processing in health sciences has been briefly explained, along with different mathematical and computational tools in geophysics and how they can be implemented for image processing in health sciences. The key findings include the development of machine learning and artificial intelligence in geophysics-driven medical imaging, demonstrating the revolutionary effects of data-driven methods on precision, speed, and predictive modeling.

Rehabilitation Towards Functional Independence in a Patient With Metastatic Carcinoma of Lung and Paraplegia: A Case Report

Lung cancer metastasis is a complex process. This case report describes a case of a 58-year-old man with carcinoma of the lung with bony metastasis to spine T9-T11 with the chief complaints of inability to move both lower limbs, breathlessness, and difficulty in bed mobility. Motor impairments may transpire in three different forms, which are paraplegia, hemiplegia, or quadriplegia. Functional electrical stimulation (FES) with body weight support treadmill training (BWSTT) is a widespread rehabilitation approach used to restore motor function of the lower limb and balance. This case report specifies the physiotherapeutic rehabilitation protocol, which includes dyspnea management, FES with BWSTT, proprioceptive neuromuscular facilitation, etc. for a patient undergoing physiotherapy The patient's occupational requirements and enhancement in executing daily living tasks were the focus of the physiotherapeutic rehabilitation. The outcomes used were the modified Medical Research Council (mMRC) grading of dyspnea and the Functional Independence Measure (FIM). We report a marked increment in muscle tone and strength, active range of motion (AROM), and significant enhancement in the individual's functional independence with physiotherapeutic protocol.

Effect of gait training using Welwalk on gait pattern in individuals with hemiparetic stroke: a cross-sectional study

Introduction

We aimed to explore the effect of gait training using Welwalk on gait patterns by comparing differences in gait patterns between robotic-assisted gait training using Welwalk and gait training using an orthosis in individuals with hemiparetic stroke.

Methods

This study included 23 individuals with hemiparetic stroke who underwent gait training with Welwalk combined with overground gait training using an orthosis. Three-dimensional motion analysis on a treadmill was performed under two conditions for each participant: during gait training with Welwalk and with the ankle-foot orthosis. The spatiotemporal parameters and gait patterns were compared between the two conditions.

Results

The affected step length was significantly longer, the step width was significantly wider, and the affected single support phase ratio was significantly higher in the Welwalk condition than in the orthosis condition. The index values of abnormal gait patterns were significantly lower while using Welwalk than in the orthosis condition. The following four indices were lower in the Welwalk condition: contralateral vaulting, insufficient knee flexion, excessive hip external rotation during the paretic swing phase, and paretic forefoot contact.

Discussion

Gait training using Welwalk increased the affected step length, step width, and single support phase while suppressing abnormal gait patterns as compared to gait training using the ankle-foot orthosis. This study suggests that gait training using Welwalk may promote a more efficient gait pattern reacquisition that suppresses abnormal gait patterns.

Trial registration

Prospectively registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCTs042180152).