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

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.