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Body weight support impacts lateral stability during treadmill walking.

ABSTRACT: Body weight support (BWS) systems are a common tool used in gait rehabilitation. BWS systems may alter the requirements for an individual to actively stabilize by 1) providing lateral restoring forces that reduce the requirements for the nervous system to actively stabilize and 2) decreasing the stabilizing gravitational moment in the frontal plane, which could increase the requirements to actively stabilize. The goal of the current study was to quantify the interaction between BWS and lateral stability. We hypothesized that when able-bodied people walk with BWS: 1) the lateral restoring forces provided by BWS would reduce the requirements to stabilize in the frontal plane when comparing dynamically similar gaits, and 2) increasing BWS would decrease the stabilizing gravitational moment in the frontal plane and increase the requirements to stabilize when speed is constrained. Our findings partly support these hypotheses, but indicate a complex interaction between BWS and lateral stability. With BWS, subjects significantly decreased step width variability and significantly increased step width (p<0.05) for both the dynamically similar and Speed-Matched conditions. The decrease in step width variability may be attributable to a combination of lateral restoring forces decreasing the mechanical requirements to stabilize and an enhanced sense of position that could have improved locomotor control. Increases in step width when walking with high levels of BWS could have been due to decreases in the gravitational moment about the stance limb, which may challenge the control of stability in multiple planes.

SUBMITTER: Dragunas AC

PROVIDER: S-EPMC5056129 | biostudies-other | 2016 Sep

REPOSITORIES: biostudies-other

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Body weight support impacts lateral stability during treadmill walking.

Dragunas Andrew C AC Gordon Keith E KE

Journal of biomechanics 20160601 13

Body weight support (BWS) systems are a common tool used in gait rehabilitation. BWS systems may alter the requirements for an individual to actively stabilize by 1) providing lateral restoring forces that reduce the requirements for the nervous system to actively stabilize and 2) decreasing the stabilizing gravitational moment in the frontal plane, which could increase the requirements to actively stabilize. The goal of the current study was to quantify the interaction between BWS and lateral s ...[more]

PMID: 27282960

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Project description:BackgroundLocomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established.MethodsWe stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke.ResultsAt 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02).ConclusionsLocomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.).

Project description:BackgroundSensory-motor perturbations have been widely used to assess astronauts' balance in standing during pre-/post- spaceflight. However, balance control during walking, where most falls occur, was less studied in these astronauts. A study found that applying either visual or platform oscillations reduced the margin of stability (MOS) in the anterior-posterior direction (MOSap) but increased MOS in the medial-lateral direction (MOSml) as a tradeoff. This tradeoff induced an asymmetric gait. This study extended the current knowledge to investigate overall stability under unpredictable environments. This study aimed to determine (1) whether quasi-random treadmill perturbations with or without full vision support would result in a significant reduction in MOSap but an increase in MOSml and (2) regardless of whether vision support was provided, quasi-random treadmill perturbations might result in asymmetric gait patterns.MethodsTwenty healthy young adults participated in this study. Three experimental conditions were semi-randomly assigned to these participants as follows: (1) the control condition (Norm), walking normally with their preferred walking speed on the treadmill; (2) the treadmill perturbations with full vision condition (Slip), walking on the quasi-random varying-treadmill-belt-speeds with full vision support; and (3) the treadmill perturbations without full vision condition (Slip_VisionBlocked, blackout vision through customized vision-blocked goggles), walking on the quasi-random varying-treadmill-belt-speeds without full vision support. The dependent variables were MOSap, MOSml, and respective symmetric indices. A one-way repeated ANOVA measure or Friedman Test was applied to investigate the differences among the conditions mentioned above.ResultsThere was an increase in MOSap in Slip (p = 0.001) but a decrease in MOSap in Slip_VisionBlocked (p = 0.001) compared to Norm condition. The MOSml was significantly greater in both Slip and Slip_VisionBlocked conditions compared to the Norm condition (p = 0.011; p < 0.001). An analysis of Wilcoxon signed-rank tests revealed that the symmetric index of MOSml in Slip_VisionBlocked (p = 0.002) was greater than in the Norm condition.ConclusionThe novelty of this study was to investigate the effect of vision on the overall stability of walking under quasi-random treadmill perturbations. The results revealed that overall stability and symmetry were controlled differently with/without full visual support. In light of these findings, it is imperative to take visual support into consideration while developing a sensory-motor training protocol. Asymmetric gait also required extra attention while walking on the quasi-random treadmill perturbations without full vision support to maintain overall stability.

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Body weight support impacts lateral stability during treadmill walking.

Publications

Body weight support impacts lateral stability during treadmill walking.

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