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

Objectives: To investigate to what extent and with how much therapeutic eff ort nonambulatory stroke patients could train a gait-like movement on a new ly 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, cha racterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as c ompared to treadmill walking (p <0.01). The pattern and amount of activatio n of relevant weight-bearing muscles was comparable with an even larger act ivation of the M. biceps femoris on the gait trainer (p <0.01). The tibiali s anterior muscle of the nonaffected side, however, was less activated duri ng 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 de vice. Conclusion: The newly developed gait trainer offered severely disabled hemi paretic subjects the possibility of training a gait-like, highly symmetrica l movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.