Effects of gait training with weight support feedback walker on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete spinal cord injury: A pilot randomized controlled trial.

BACKGROUND: Spinal cord injury (SCI) is a devastating condition affecting an individual's life, particularly through lower extremity paralysis, which limits walking and daily activities. OBJECTIVES: This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI). METHODS: Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training. RESULTS: The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05). CONCLUSION: WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.

Immediate effect of weight load on lower limb muscle activity and gait ability in patients with incomplete spinal cord injury during walker gait training.

OBJECTIVE: Walkers are actively used to improve gait ability in patients with incomplete spinal cord injury (ISCI). This study aimed to investigate the immediate effect of weight load during walker gait training on lower limb muscle activity and gait ability in patients with ISCI using a dependence feedback walker (DFW). DESIGN: A single group cross-sectional design. SETTING: Local rehabilitation hospital. PARTICIPANTS: Fourteen patients with ISCI (62.00 years, Onset duration: 20.57months). INTERVENTIONS: The DFW was used to measure the change in lower limb muscle activity and gait ability on walker dependence during the 20-meter walk. Based on the initial measurement of walker dependence, three levels of walker dependence threshold were set (100%, 60%, and 20%). If the weight loaded on the walker exceeded the three threshold levels of walker dependence, auditory and visual feedback was generated. OUTCOME MEASURES: During the 20-meter walk, changes in both lower limb muscle activity (rectus femoris, biceps femoris, medial gastrocnemius, tibialis anterior, and gluteus medius) and gait ability (velocity, cadence, and single-limb support phase) were measured by surface electromyography and 3-axis accelerometer. RESULTS: The increase in lower limb muscle activation and improvement of gait ability were greater during 20% walker dependence gait training than during 100% walker dependence gait training (P < 0.05). CONCLUSION: Reduction of walker dependence by extrinsic feedback generated via DFW during walker gait training may lead to increased lower limb muscle activity and improved gait. These results could be useful for successful self-gait training and improving walking independence in patients with ISCI.

Walking Training with a Weight Support Feedback Cane Improves Lower Limb Muscle Activity and Gait Ability in Patients with Chronic Stroke: A Randomized Controlled Trial.

BACKGROUND Induction of proper weight transfer to the affected lower limb should be considered the most essential factor for successful stroke cane gait training. This study aimed to investigate the effect of walking training with a weight support feedback cane on lower limb muscle activity and gait ability of chronic stroke patients. MATERIAL AND METHODS Thirty stroke patients were randomized into 2 groups: a weight support feedback cane gait training group (WSFC group, n=15) and a conventional cane gait training group (CC group, n=15). All subjects were enrolled in standard rehabilitation programs for 4 weeks. Additionally, the WSFC group participated in WSFC gait training and the CC group participated in conventional cane gait training for 4 weeks. During WSFC gait training, the weight support rate loaded on the cane was reduced by 10% every week from 60% to 30% based on the measured initial cane dependence, while the CC group participated in conventional cane gait training with verbal instruction to reduce cane dependence. Lower limb muscle activity and gait ability were measured using wireless surface electromyography and a 3-axis accelerometer during walking. RESULTS The WSFC group showed significantly greater improvement than the CC group in lower limb muscle activity and gait ability (P<0.05). CONCLUSIONS Cane gait training significantly improved lower limb muscle activity and gait ability in stroke regardless of the training method; however, the addition of real-time weight support feedback to cane gait training appears to provide further benefit compared with conventional cane gait training in chronic stroke patients.