Body-Weight- Supported Gait Training Mary Bernardo, Katie Blow, Lauren Bussian, Kaylea Kirven, Sarah...
-
Upload
frank-watts -
Category
Documents
-
view
217 -
download
0
Transcript of Body-Weight- Supported Gait Training Mary Bernardo, Katie Blow, Lauren Bussian, Kaylea Kirven, Sarah...
Body-Weight- Supported Gait
Training
Mary Bernardo, Katie Blow, Lauren Bussian, Kaylea Kirven, Sarah Nockengost
Alternative Intervention PresentationLifespan 1 2015
Virginia Commonwealth University
Body-Weight-Supported Treadmill Training (BWSTT)
Body-Weight Supported Treadmill Training, Colorado Physical Therapy Specialists
●Used in a variety of practice settings
●Targets strength, endurance, and task-specific gait training
●Body weight is unloaded by a harness or adult assistance
●Active movements with therapist guidance/assistance when necessary
●Generally followed by a period of overground gait training with body-weight support as needed
Video
https://www.youtube.com/watch?v=XLdctmNvACo
Background
●Systematic Review of pediatric studies in 2006
Only 7 articles from peer-reviewed sources
●Still preliminary in pediatric population
●1960’s - Animal research proved that cats with transected spinal cords could actively step after a period of BWSTT
●1992 – Wernig and Muller reported improved walking patterns following BWSTT in patients with SCI
Rationale• Motor Learning principles support the
use of repetitive, task-specific practice over time
• Current evidence demonstrates the neuroplasticity of the central nervous system, indicating its ability to learn
• Body-Weight-Supported Gait Training provides the appropriate intensity and specificity needed to promote neuroplastic changes.
• Facilitates step training• Reduces postural requirements• Encourages more appropriate motor
patterns
APTA Guidelines for Use of Body-Weight-Supported Treadmill Training (APTA’s Section on Pediatrics, 2010)
Frequency 2-5 days/week
Session Length 5-30 minutes/session
Treadmill Speed .05-3 mph
Percent Body-Weight Support Load stance limb
Use the least amount of body-weight support to maintain erect postural alignment
Manual Assistance Least amount required for steppingAssist intra- and inter-limb coordination if necessary
Support Using arms/hands Fading use of handrails
Episode of Treatment 2-16 weeks
Equipment
• Various equipment used for BWSTT Examples:
• LiteGait System:• May require manual assistance requiring 2-
4 trained providers• Lokomat:
• Provides robotic assistance during body-weight- supported gait training
• Therapist Support
Lokomat®LiteGait®
Continuing Education/Training
• Certification and continuing education are not required to utilize BWSTT in physical therapy intervention
• Many companies offer training for use of their products
•LiteGait ($850-$140)•Lokomat
Patient Population
• Down Syndrome
• Cerebral Palsy (CP)
• Spinal Cord Injury (SCI)
• Myelomeningocele
• Stroke
• Guillain-Barre Syndrome
• Traumatic Brain Injury (TBI)
Contraindications
• Cardiovascular issues• Osteoporosis• Fractured ribs• Groin infection or skin graft in groin area• Weight-bearing restrictions• Ventilator dependency• Intravenous drip• Self-harming behavior• **Any contraindication to exercise
(Ex: orthostatic hypotension, thrombocytopenia)
A Systematic Review of the Effectiveness of Treadmill Training and Body Weight Support in
Pediatric RehabilitationDamaino, D. et. al. (2009) Journal of Neurological Physical Therapy
Purpose: To explore the strength, quality, and conclusiveness of the scientific evidence supporting BWSTT in children with motor disabilities.
Design: 29 articles met inclusion criteria.
Results for CP:- Highest level study: significant increase in self-selected gait
speed and walking distance- High variability across subjects in the amount of change- Positive effects are small and mostly non-significant- No harmful outcomes
Conclusion: Limited evidence that has non-significant outcomes; has not been compared sufficiently to other interventions
A Systematic Review of the Effectiveness of Treadmill Training and Body Weight Support in Pediatric Rehabilitation
Damaino, D. et. al. (2009) Journal of Neurological Physical Therapy
Results for Down Syndrome:• Highest level study: practicing step training on a
motor treadmill can accelerate development of ambulation
• More intense protocol is preferred over lower intensity levels
- Long term effect on physical activity levels- Greater stride length- Earlier age of walking onset
Conclusion: Body-weight-supported treadmill training is effective for promoting the development of independent ambulation and enhancing gait qualities.
A Systematic Review of the Effectiveness of Treadmill Training and Body Weight Support in
Pediatric RehabilitationDamaino, D. et. al. (2009) Journal of Neurological Physical Therapy
Results for SCI: - Mostly positive outcomes with clinically significant
changes.- Many children became functional ambulators.- Lack of change in lower extremity motor strength
indicates task-specificity of practice.- Data is limited in children compared to adults.- No negative or harmful effects were found.
Conclusion: Limited evidence warrants more rigorous studies in this patient population
Treadmill Training of Infants With Down Syndrome: Evidence-Based Developmental
OutcomesDale A. Ulrich, PhD, Beverly D. Ulrich, PhD, Rosa M. Angulo-Kinzler, PhD, Joonkoo Yun,
PhD
Purpose: To determine if practice stepping on a motorized treadmill could help reduce the delay in walking onset normally experienced in infants with Down Syndrome.
Design: n = 30; began study once able to sit independently for 30 sec.
Control Group Experimental Group
Biweekly PTHEP
Adult assist treadmill stepping practice8 minutes/day, 5 days/weekSpeed .46mphBiweekly home PT and research staff visitsHEP
Treadmill Training of Infants With Down Syndrome: Evidence-Based Developmental
OutcomesDale A. Ulrich, PhD, Beverly D. Ulrich, PhD, Rosa M. Angulo-Kinzler, PhD, Joonkoo Yun, PhD
Results: Length of time (days) from entry of study to onset of:
Conclusion: Body-Weight-Supported Treadmill Training is an effective approach in early intervention to facilitate earlier onset of independent walking.
Control Group
Experimental Group
Mean Difference
Raise to Stand 194 134 60
Walking with Help 240 166 73
Walking Independently
401 300 101
Efficacy of Partial Body-Weight-Supported Treadmill Training [PBWSTT] Compared With Overground Walking Practice for Children With
Cerebral PalsyWilloughby, et al. (2010) Disabil. Rehabil.
Purpose:• Determine safety and feasibility of PBWSTT in a school
environment
• Investigate if PBWSTT can increase walking endurance, walking speed, and walking function at school for children – adolescents with CP (GMFCS III & IV)
Design:• Inclusion Criteria:
• Ages 5 – 18 years old
• Diagnosis of CP
• GMFCS Level III or IV
• Able to understand simple instructions
• Exclusion Criteria:
• Physical assistance to walk
• Concurrent medical condition
• Lower limb orthopedic surgery or botulinum toxin injection within 6 months of study
Willoughby, et al. (2010)
n = 26
Outcome Measures: Baseline, Week 10, 14 weeks after training
- 10-meter Walk Test - 10-minute Walk Test
- School Function Assessment
Willoughby, et al. (2010)
Results:
Conclusion:
–PBWSTT is safe & feasible to conduct in a school setting for children with CP
–But, BWSTT is no more effective than practicing overground walking
Limitations:
–Q of L, psychological outcomes, physiological outcomes not measured
–Severity of CP
Locomotor Training Within an Inpatient Rehabilitation Program After Pediatric
Incomplete Spinal Cord Injury: A Case StudyProsser, L. (2007) Phys. Ther.
Purpose: Describe a comprehensive inpatient rehabilitation program with a locomotor training component in a child with a severe incomplete SCI.
Patient: 5 y/o female with C4 level lesionIntervention: Inpatient rehabilitation program including a
component of BWSTT and overground gait training; 3-4x/week for 6 months
Outcome Measures: ASIA Impairment scale, WeeFIM II, Walking Index for Spinal Cord Injury II, Parent-report
Results: • Walking independently with rolling walker and L AFO (30-
100m)• Clinically significant improvements in UE and LE motor
scores• Clinically significant improvements in WeeFIM II and WISCI
II scores• Participation - walking in school 100% of the time
ICF
ICF
ICF
Recommendations
● Safe!
● Positive results in certain pediatric populations
● Financial burden
● Time-intensive○ When do we stop working on gait and focus on
other skills?
● Need more RCTs and studies comparing BWSTT to other gait training methods
References:• Body-Weight-Supported Treadmill Training: Using Evidence to Guide Physical
Therapy Intervention. Section on Pediatrics, American Physical Therapy Association. 2010.
• Body-Weight Supported Treadmill Training. University of Washington Rehabilitation Medicine, 2003. Web. <http://sci.washington.edu/info/newsletters/articles/03sp_body_weight_support.asp>.
• Behrman AL, Harkema SJ. Locomotor Training after Human Spinal Cord Injury: A Series of Case Studies. Physical Therapy. 2000;80(7):688-700.
• Litegait Training. https://www.litegait.com/education/litegait-training• Rehabilitation Institute of Chicago. Pediatric Lokomat Walking Therapy.
http://www.ric.org/conditions/pediatric/services/pediatric-lokomat-walking-therapy/
• Duncan, PW, et. al. Body-Weight-Supported Treadmill Training Rehabilitation after Stroke. N Engl J Med. 2011. 364 (21).
• Damiano DL, DeJong, SL. A Systematic Review of the Effectiveness of Treadmill Training and Body Weird Support in Pediatric Rehabilitation. J Neurological Phys. Ther. 2009; 33: 27-44.
• Ulrich DA, Ulrich BD, Angulo-Kinzler RM, Yun J. Treadmill training of infants with Down syndrome: evidence-based developmental outcomes. Pediatrics 2001;108
• Willoughby, KL, et. al. Efficacy of partial body-weight supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial. Archives Phys. Med. Rehabil. 2010. (3) 333-9.
• Prosser L. Locomotor Training Within an Inpatient Rehabilitation Program After Pediatric Incomplete Spinal Cord Injury. Phys. Ther. 2007; 87: 1124-1232.
Questions?