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Intervention 干预
Body Weight Support System and Treadmill
The BWS system used was the Lite Gait I.The system consists of an adult-sized frame with an adjustable handrail.The harne and 2 points of BWS provide needed postural and weight support.locking wheels allow BWS ambulation training
with a treadmill as well as overground.A bilateral symmetry scale mounted within the frame
displays the amount of weight supported by
the device at any particular moment.The treadmill used was the Proform Crowalkwhich had a 35-_ 114-cmwalking surface and ranged in speed from 0.1mph(0.04 m/s)to 10 mph(4.44 m/s).Overview of Intervention
BWS ambulation training occurred 2 to 3 times per week over a 6-to 7-week period.In each seion, there were 4 bouts of ambulation.The first 3 bouts consisted of ambulation on the treadmill with
BWS, and the fourth bout consisted of overground ambulation with BWS.Bouts were separated by a 5-minute rest interval.The duration of each bout was limited by participant toleranceor to a maximum of 10 minutes.At initiation of the intervention, 40% of each participant’s body weight was supported.This percentage of BWS was selected based on research that demonstrated that support greater than 40% actually interfered with heel-ground contact for some patients.Participants were started on the treadmill at 0.5 mph(0.22 m/s).Body weight support consisted of 3 levels: 40%, 20%, and 0% of body weight.Treadmill speed also consisted of 3 levels: 0.5 mph(0.22 m/s), 0.75 mph(0.33 m/s), and 1.0 mph(0.44 m/s).Progreion was accomplished by decreasing BWS or increasing treadmill speed.We considered the participants as having an adequate gait technique if they were able to support weight on the affected limb without buckling, along with somewhat consistent and symmetrical step length, cadence, and foot clearance.If adequate gait technique was achieved, the percentage of BWS was decreased to the next level.We defined adequate endurance as occurring when the participants could ambulate more than 5 minutes in 2 of 3 treadmill bouts.If adequate endurance was achieved, speed was increased to the next level.Speed of ambulation during overground walking was primarily determined by the participant.During treadmill and overground walking, verbal cueing and manual guidance were given.Participant A
Participant A completed 21 days of intervention over a 7-week period.Each bout of ambulation was stopped if the participant reported fatigue.The drops in average intervention time on days 5, 8, 12, and
21, as noted in Table 2, correlated with progreion to a more demanding level.For example, BWS was decreased from 40% to 20% on day 8, and average
intervention time decreased from 4 minutes 51 seconds to 2 minutes 48 seconds.Overground BWS ambulation speed increased acro treatment seions,as evidenced by mean speeds of 0.33 mph(0.15 m/s)at
level 1 and 0.74 mph(0.33 m/s)at level 5(Tab.2).Participant B
Participant B completed 17 days of intervention over a 6-week period.The protocol for progreion of intervention was altered
on 2 occasions(Tab.3).The percentage of BWS was reduced from 40% initially to 20% on day 2 of intervention without achieving adequate gait technique
We prematurely reduced BWS because of her tendency to collapse into
the harne with 40% of BWS.In addition, the speed of the treadmill was increased to 0.75 mph(0.44 m/s)on intervention day 14 without attaining adequate symmetry.We made this change because she had not achieved the symmetry requirements to decrease BWS or increase speed after 4 weeks of intervention.This change in speed aisted with more appropriate foot placement and step length.Her speed increased acro intervention from a
mean speed of 0.28 mph(0.12 m/s)at
level 1 to a mean speed of 0.67 mph
(0.30 m/s)at level 3.Outcomes
Participant A
Her ambulation improved, as indicated by all measurements.She demonstrated improved balance, as indicated by her
Berg Balance Scale scores(26/56 pretest to 40/56
posttest).Her walking improved, as demonstrated by her scores on the Tinetti Gait and Balance Aement.Her 10-m walking time(with rolling walker)improved from
0.35 m/s to 0.65 m/s , and her right
and left step lengths improved by 35% and 41%, respectively.Our observation of participant A’s gait indicated a
more symmetrical gait pattern than before intervention.Following intervention, participant A stated that “she felt
like she was walking faster and was more conscious about
taking larger steps.”
Participant B
Minimal improvements in gait and balance were evident.The greatest improvements were a 22% improvement in
10-m walking time(while pushing her wheelchair)and
improvements in step length.Step length improved
more on the right(35%)than on the left(25%), which
accounts for the decrease in step length ratio.Our
observation of gait led us to believe that there were
inconsistent improvements in step length and foot clearance
bilaterally.Although participant B was unable to provide useful
information about her performance or the intervention,her daughter stated that she was more social and alert during the day throughout the duration of the intervention.
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