Restoring the ability to walk is a key step toward independence
Restoring the ability to walk is a key step toward independence

Pelvic Support

A New Concept in Locomotion Training, With Dynamic Body Weight Support (DBWS)

Klainer Giora; MHA, B.PT. Easy Walking

Restoring the ability to walk is a key step toward independence. For people with severe mobility limitation, it can be the difference between life in an institution or being able to perform in their home setting (8). Therefore locomotion training is one of the main goals of physical rehabilitation and walking recovery (1, 6).

The approach of locomotion training using the technology of Dynamic Body Weight Support (DBWS) has been in use for many years. It is one of the evidence-based clinical approaches that will be in used in the 21st century, to enhance recovery of posture and locomotion in neurological and orthopedic injured subjects (5, 9). DBWS method enables dynamic and targeted practice of four main essential components of the act of locomotion (1, 2, 4).

  • Transition to stand
  • weight bearing, and weight transfer /shifting
  • Maintaining balance,( especially during stance phase)
  • Taking steps, (step length and cadence)

This new concept of pelvic support harness that is used, in the Up n’ Go by Easy Walking, reacts under the center of mass creating the natural pattern of movement “The Inverted Pendulum Mechanism” that simulates the human locomotion (11). Pelvic support harness provides modern approaches to motor learning using the technology of DBWS. Such as: task specificity training of walking and balance in both feed-forward and feedback modes (5). With allowing the initiation of movement from the lower trunk and pelvis. This can be performed in the rehabilitation institution, and more importantly, it sets up the building blocks for patients to perform in the home setting, to continue practice with more normal gait pattern in the home training. The Up n’ Go is composed of a frame that is attached to a harness which supports the pelvic area (below center of mass), so that there is no need for upper extremity support, “hands free motion” (10). The Up n’ Go shifts the support of the user’s body weight to a system of gas springs that can be adjusted as the patient’s strength and ability of movement progresses or conditions improve.

This locomotion trainer is portable, can rotate 360° in a very small radius and is as wide as a standard wheel chair.

Studies on locomotor training with DBWS indicate that this method improves gait by giving stability to the trunk area (trunk control), lessens the need for maintaining balance, allows weight shifting and enables cyclical walking. These elements of facilitation of motion emphasize the pro-vision of hip extension position and load bearing, as well as other sensory elements contribute to the control of walking and make it possible to use locomotor training at a very early stage of the rehabilitation process (7). The caregiver benefits from the ability to stand next to the patient and to observe and monitor the quality of the locomotion components (1). Locomotor Training with DBWS was found to be safe to use in the acute stages of the rehabilitation process (4). The improvement in the locomotion components is also transferable to walking while bearing full weight and therefore achieves general improvement in the patient’s mobility, and quality of life (3, 8).

References

  1. Dickshtein R. the physical care of stroke patients. Gerontologia, Vol. 29(1–2) Ramot publication — Tel Aviv University, 2002; 81–100 (Hebrew)
  2. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on post stroke locomotor recovery; Arch. Phys. Med. Rehabil. 2002; 83: 683–691.
  3. Teixeira da Cunha J, Lim PA, Qureshy H, Henson H, Monga T. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. Arch Phys Med Rehabil. 2002; 83: 1258–1265.
  4. Visintin, M, Barbeau H, Korner-Bitensky N, Mayo NE. A New Approach to Retrain Gait in Stroke Patients Through Body Weight Support and Treadmill Stimulation; stroke. 1998;29 : 1122–1128.
  5. Barbeau H. Locomotor training in neurorehabilitation: Emerging rehabilitation concepts. Neurorehabil Neural Repair. 2003;17:3–11.
  6. Behrman A l, Bowden, MG, Nair, PM. Neuroplasticity After Spinal Cord Injury and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery. Phys Ther.2006; 86:1406–1423
  7. Dietz V, Harkema SJ. Locomotor activity in spinal cord-injured persons. J Appl Physiol. 2004;96:1954–1960
  8. Mayo NE, Wood-Dauphinee S, Cote’ R, et al. There’s No Place like Home; Stroke. 2000; 31:1016–1024.
  9. Hesse S, Werner C, Bardeleben A, Barbeau H. Body Weight-Supported Treadmill Training after stroke. Curr Atheroscler Rep.2001; 3:284–294.
  10. Visintin, M, Barbeau H. The effect of parallel bars, body Weight Support and speed on the modulation of the locomotor pattern of spastic paretic gait: preliminary communication. Parapplegia.1994;32:540–553
  11. Winter DA. The Biomechanics and Motor Control of Human gait: Normal, Elderly and Pathological. 1991 second Ed. Chapter 6.
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