Should Body Weight–Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate?

Neurorehabil Neural Repair, 2012 · DOI: 10.1177/1545968312439687 · Published: May 1, 2012

Simple Explanation

Body weight–supported treadmill training (BWSTT) and robotic-assisted step training (RAST) have not proven more effective than over-ground training (OGT) for individuals with motor impairments due to stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, or cerebral palsy. The initial belief was that BWSTT and RAST could leverage central pattern generators (CPGs) and promote neuroplasticity, but randomized clinical trials have not supported these assumptions. Until there is more evidence of effectiveness, BWSTT and RAST should not be routinely used in place of over-ground training for disabled persons outside of scientifically conducted trials.

Study Duration

Not specified

Participants

Patients with stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, or cerebral palsy

Evidence Level

Review of Randomized Clinical Trials

Key Findings

1
BWSTT and RAST do not consistently outperform conventional over-ground training in improving walking ability in patients with neurological conditions.
2
Initial pilot studies suggested potential efficacy of BWSTT, but subsequent meta-analyses and RCTs have shown equivalence to other forms of therapy.
3
A higher initial level of motor control is a better predictor of achieving independent walking than the specific intervention used (BWSTT or RAST).

Research Summary

Body weight-supported treadmill training (BWSTT) and robotic-assisted step training (RAST) were initially promising rehabilitation interventions for individuals with motor impairments. However, randomized clinical trials have shown that these interventions are not superior to conventional over-ground training (OGT) in improving walking ability for patients with stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, or cerebral palsy. The authors suggest that future research should focus on developing new strategies for functional practice with devices and ensuring that interventions are based on well-defined experimental evidence before widespread adoption.

Practical Implications

Re-evaluate Treatment Strategies

Clinicians should reconsider the routine use of BWSTT and RAST, focusing instead on evidence-based over-ground training methods.

Focus on Patient Engagement

Future research should explore ways to enhance patient engagement and cognitive involvement during device-based training to improve motor learning outcomes.

Personalized Rehabilitation

Assess individual patient characteristics, such as initial motor control, to tailor interventions and predict potential responders to specific treatments.

Study Limitations

1
Animal models may not accurately translate to human neurorehabilitation.
2
Pilot studies often suffer from biases that overestimate the effectiveness of interventions.
3
Outcome measurements may not fully capture real-world walking abilities.

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