A Bibliography on Body Weight Support Treadmill Training

Prepared by Paul D. Hansen, Ph.D., P.T., 20 January 2000

Basic Science - Review Papers

• Armstrong DM. Supraspinal contributions to the initiation and control of locomotion in the cat. Progress in Neurobiology 1986; 26: 273-361.

  This is probably the most comprehensive review of the neuroanatomy of locomotion. The paper emphasizes cerebellar anatomy and reads like a neuroantomy textbook. I would recommend reading it after having read one of the other reviews.

• Forssberg H, Grillner S, Halbertsma J. The locomotion of the low spinal cat. I. Coordination within a hindlimb. Acta Physiologica Scandinavica 1980; 108: 269-281.
• Forssberg H, Grillner S, Halbertsma J, Rossignol S. The locomotion of the low spinal cat. II. Interlimb coordination. Acta Physiologica Scandinavica 1980; 108: 283-295.

  Forssberg and Grillner's reviews set the stage for the clinical research.

• Grillner S, Dubuc, R. Control of locomotion in vertebrates: Spinal and supraspinal mechanisms. In: Waxman SG, Advances in Neurology, Vol. 47: Functional Recovery in Neurological Disease. Raven Press, New York. 1988; 425-453.

  This is an excellent review, although slightly dated.

• Hultborn H, Conway BA, Gossard JP, Brownstone R, Fedirchuk B, Schomburg ED, Enriquez-Denton M, Perreault MC. How do we approach the locomotor network in the mammalian spinal cord? Annals of the New York Academy of Sciences 1998; 860: 70-82.
• Jordan LM Initiation of locomotion in mammals. Annals of the New York Academy of Sciences 1998; 860: 83-93.
• Mori S. Neurophysiology of locomotion: Recent advances in the study of locomotion. Annals of the New York Academy of Sciences 1998; 860: 55-78.
• Pearson KG. Proprioceptive regulation of locomotion. Current Opinion in Neurobiology 1995; 5: 786-791.

  A discussion of the critical afference needed for gait.

• Rossignol S. Neural control of stereotypic limb movements. In: Rowell LB, Shepherd JT. Exercise: Regulation and integration of multiple systems, Handbook of Physiology; Section 12. Oxford Universty Press, New York 1996; 174-216.

  Rossignol does an excellent job of reviewing the literature across species; highly recommended.

• Whelan PJ. Control of locomotion in the decerebrate cat. Progress in Neurobiology 1996; 49: 481-515.

  My favorite review paper. The information is current and actually readable.

• Wickelgren I. Teaching the spinal cord to walk. Science 1998; 279: 319-321.
• Peason KG, Misiaszek JE, Fouad K. Enhancement and resetting of locomotor activity by muscle afferents. Annals of the New York Academy of Sciences 1998; 860: 203-215.

Basic Science (primarily cat) - Neurology of Locomotion

There is extensive literature in this domain.

• Andersson O, Forssberg H, Grillner S, Wallen P. Peripheral feedback mechanisms acting on the central pattern generators for locomotion in fish and cat. Canadian Journal of Physiology and Pharmacology 1981; 59: 713-726.
• Beresovskii VK. Structure of spinal cord locomotor strip in the cat. Acta Neurobiologiae Experimentalis 1990; 50: 41-46.
• Blaszczyk J, Loeb GE. Why cats pace on the treadmill. Physiology and Behavior 1993; 53: 501-507.
• Drew T, Dubuc R, Rossignol S. Discharge patterns of reticulospinal and other reticular neurons on chronic, unrestrained cats walking on a treadmill. Journal of Neurophyisology 1986; 55: 375-401.
• Forssberg H, Grillner S, Rossignol S. Phase dependent reflex reversal during walking in chronic spinal cats. Brain Research 1975; 85: 103-107.
• Grillner S, Ekeberg O, Manira AE, Lansner A, Parker D, Tegner J, Wallen P. Intrinsic function of a neuronal network -- a vertebrate central pattern generator. Brain Research Review 1998; 26: 184-197.
• Mori S, Matsui T, Kuze B, Asanome M, Nakajima K, Matsuyama K. Cerebellar-induced locomotion: Reticulospinal control of spinal rhythm generating mechanism in cats. Neuroscience Research 1998; 30: 257-269.
• Mori S, Matsui T, Kuze B, Asanome M, Nakajima K, Matsuyama K. Stimulation of a restricted region in the midline cerebellar white matter evokes coordinated quadrupedal locomotion in the decerebrate cat. Journal of Neurophysiology 1999; 82 : 290-300.
• Widajewicz W, Kably B, Drew T. Motor cortical activity during voluntary gait modifications in the cat. II Cells related to the hindlimbs. Journal of Neurophysiology 1994; 72: 2070-2089.
• Yu J, Eidelberg E. Recovery of locomotor function in cats after localized cerebellar lesions. Brain Research 1983; 273: 121-131.
• Shimamura M, Kogure I. Discharge patterns of reticulospinal neurons corresponding with quadupedal leg movements in thalamic cats. Brain Research 1983; 230: 27-34.

Basic Science (primarily cat) - Neurology of LEARNING Locomotion

• Barbeau H, Rossignol S. Recovery of locomotion after chronic spinalization in the adult cat. Brain Research 1987; 412: 84-95.
• Brustein E, Rossignol S. Recovery of locomotion after ventral and ventrolateral spinal lesions in the cat. I. Deficits and adaptive mechanisms. Journal of Neurophysiology 1998; 80: 1245-1267.

  Discusses the need for the reticulospinal system.

• De Leon RD, Hodgson JA, Roy RR, Edgerton VR. Retention of hindlimb stepping ability in adult spinal cats after the cessation of step training. Journal of Neurophysiology 1999; 81: 85-94.
• De Leon RD, Tamaki H, Hodgson JA, Roy RR, Edgerton VR. Hindlimb locomotor and postural training modulates glycinergic inhibition in the spinal cord of the adult spinal cat. Journal of Neurophysiology 1999; 82: 359-369.
• Hodgson JA, Roy RR, de Leon, R, Dobkin B, Edgerton VR. Can the mammalian lumbar spinal cord learn a motor task? Medicine and Science in Sports and Exercise 1994; 26: 1491-1497.

  In this paper is hidden the data which shows standing training leads to poor treadmill performance.

• Loverly RG, Gregor RJ, Roy RR, Edgerton VR. Effects of training on the recovery of full-weight-bearing stepping in the adult spinal cat. Experimental Neurology 1986; 92: 421-435.

  The original paper that showed the dramatic effects of training.

• Loverly RG, Gregor RJ, Roy RR, Edgerton VR. Weight-bearing hindlimb stepping in treadmill-exercised adult spinal cats. Brain Research 1990; 514: 206-218.
• Smith JL, Edgerton VR, Eldred E, Zernicke RF. The chronic spinalized cat: A model for neuromuscular plasticity. Birth defects original article series 1983; 19: 357-73.
• Smith JL, Smith LA, Zernicke RF, Hoy M. Locomotion in exercised and nonexercised cats cordotomized at two or twelve weeks of age. Experimental Neurology 1982 May; 76: 393-413.
• Whelan PJ, Pearson KG Plasticity in reflex pathways controlling stepping in the cat. Journal of Neurophysiology 1997; 78: 1643-1650.

Clinical Review Papers

At the present time I think the original research is almost as informative as the review papers. Most of the review papers focus on SCI.

• Barbeau H, Ladouceur M, Norman KE, Pepin A, Leroux A. Walking after spinal cord injury: Evaluation, treatment, and functional recovery. Archives of Physical Medicine Rehabilitation 1999; 80: 225-235.
• Barbeau H, McCrea DA, O'Donovan MJ, Rossignol S, Grill WM, Lemay MA. Tapping into spinal circuits to restore motor function. Brain Research Reviews 1999; 30: 27-51.

  A very good review with an emphasis on spinal CPG control. They also discuss pharmacological and FES. Their use of FES is unique as they use it to drive sensory signals which then recruit the motor output.

• Barbeau H, Norman K, Fung J, Visintin M, Ladouceur M. Does neurorehabilitation play a role in the recovery of walking in neurological populations? Annals of the New York Academy of Sciences 1998; 860: 377-92.
• Barbeau H, Rossignol S. Enhancement of locomotor recovery following spinal cord injury. Current Opinion in Neurology 1994; 7: 517-524.
• Duysens J, Van de Crommert HWAA. Neural control of locomotion; Part 1: The central pattern generator from cats to humans. Gait and Posture 1998; 7: 131-141.
• Van de Crommert HWAA, Mulder T, Duysens J. Neural control of locomotion; Part 2: Sensory control of the central pattern generator and its relation to treadmill training. Gait and Posture 1998; 7: 251-263.
• Edgerton RE, Roy RR, Hodgson JA, Prober RJ, de Guzman CP, de Leon R. Potential of adult mammalian lumbosacral spinal cord to execute and acquire improved locomotion in the absence of supraspinal input. Journal of Neurotrauma 1992; 9: S119-S128.
• Finch L, Barbeau H. Hemiplegic gait: new treatment strategies. Physiotherapist Canada 1986; 38: 36-41.

  This is the first recent discussion of using body weight support gait training - they postulated that BWS gait training would work following stroke.

• Ladouceur M, Pepin A, Norman KE, Barbeau H. Recovery of walking after spinal cord injury. Advances in Neurology 1997; 72: 249-255.
• Pinter MM, Dimitrijevic MR. Gait after spinal cord injury and the central pattern generator for locomotion. Spinal Cord 1999; 37: 531-537.
• Rossignol S, Chau C, Brustein E, Belanger M, Barbeau H, Drew T. Locomotor capacities after complete and partial lesions of the spinal cord. Acta Neurobiologiae Experimentalis 1996; 56: 449-463.
• Rossignol S, Chau C, Brustein E, Giroux N, Bouyer L, Barbeau H, Reader TA. Pharmacological activation and modulation of the central pattern generator for locomotion in the cat. Annals of the New York Academy of Sciences 1998; 860: 346-359.

Clinical Research - Spinal Cord Injury

• Barbeau H, Wainberg M, Finch L. Description and application of a system for locomotor rehabilitation. Medical and Biological Engineering and Computing 1987; 25: 341-344.

  This paper describes a device and the effect of 20 & 40 BWS on gait speed with 6 patients with SCI.

• Dietz V. Evidence for a load receptor contribution to the control of posture and locomotion. Neuroscience and Biobehavioral Reviews 1998; 22: 495-499.
• Dietz V, Colombo G, Jensen L, Baumgartner L. Locomotor capacity of spinal cord in paraplegic patients. Annals of Neurology 1995; 37: 574-582.
• Dimitrijevic MR, Gerasimenko Y, Pinter MM. Evidence for a spinal central pattern generator in humans. Annals of the New York Academy of Sciences 1998; 860: 360-376.
• Harkema SJ, Hurley SL, Patel UK, Requejo PS, Dobkin BH, Edgerton VR. Human lumbosacral spinal cord interprets loading during stepping. Journal of Neurophysiolog 1997; 77: 797-811.
• Muir GD, Steeves JD. Sensorimotor stimulation to improve locomotor recovery after spinal cord injury. Trends in Neuroscience 1997; 20: 72-77.
• Norman KE, Pepin A, Ladouceur M, Barbeau H. A treadmill apparatus and harness support for evaluation and rehabilitation of gait. Archives of Physical Medince and Rehabilitation 1995; 76: 772-778.
• Van Faassen F, Molen NH. A new method in the treatment of gait disorders. Medine and Sport 1973; 8: 489-491.
• Wernig A, Muller S. Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries. Paraplegia 1992; 30: 229-238.
• Wernig A, Muller S, Nanassy A, Cagol E. Laufband therapy based on "Rules of Spinal Locomotion" is effective in spinal cord injured persons. European Journal of Neuroscience 1995; 7: 823-829.
• Zehr PE, Stein RB. What functions do reflexes serve during human locomotion? Progress in Neurobiology 1999; 58: 185-205.
• Pillar T, Dickenstein R, Smolinski Z. Walking Re-education with Partial Relief of Bodyweight Support in Rehabilitation of Patients with Locomotor Disabilities Journal of Rehabilitation Research 1991; 28: 47-52.

Clinical Research - Stroke

• Hesse S, Bertelt C, Jahnke, MT, Schaffrin A, Baake P, Malezic M, Mauritz KH. Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke 1995; 26: 976-981.

  This is the ABA study showing the dramatic effect of BWS gait training. Unfortunately, with only seven patients.

• Hesse S, Bertelt C, Schaffrin A, Malezic M, Mauritz KH. Retoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. Archives of Physical Medicine and Rehabilitation 1994; 75: 1087-1093.

  Nine nonambulatory patients who had "failed" after 3 weeks of PT dramatically improved with only three weeks of BWS gait training.

• Hesse S, Helm B, Krajnik J, Gregoric M, Mauritz KH. Treadmill training with partial body weight support: Influence of body weight release on the gait of hemiparetic patients. Journal of Neurologic Rehabilitation 1997; 11: 15-20.
• Hesse S, Jahnke MT, Schaffrin A, Lucke D, Reiter F, Konrad M. Immediate effects of therapeutic facilitation on the gait of hemiparetic patients as compared with walking with and without a cane. Electroencephalography and Clinical Neurophysiology 1998; 109: 515-522.
• Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Archives of Physical Medicine and Rehabilitation 1999; 80: 421-427.

  Hemiparetic gait is more "normal" with BWS.

• Hesse S, Malezic M, Schaffrin A, Mauritz K. Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients. Scandinavian Journal of Rehabilitation Medicine 1995; 27: 199-204.
• Hesse S, Sarkodie-Gyan T, Uhlenbrock D. Development of an advanced mechanized gait trainer, controlling movement of the center of mass, for restoring gait in non-ambulant subjects. Biomedizinische Technik 1999; 7-8: S194-201.
• Hesse S, Uhlenbrock D, Sarkodie-Gyan T. Gait pattern of severely disable hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clinical Rehabilitation 1999; 13: 401-410.
• Visintin M, Barbeau H. The effect of body weight support on the locomotor pattern of spastic paretic patients. Canadian Journal of Neurological Science 1989; 16: 315-325.

  It works - the kinematic and EMG data.

• 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. A preliminary communication. Paraplegia 1994; 32: 540-553.

  Did you know that parallel bars were so bad?

• 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.

  The best study on hemiplegic gait training. 100 patients randomized into two groups. The results are difficult to argue with.

Clinical Research - Cerebral Palsy

• Richards CL, Malouin F, Dumas F, Marcoux S, Lepage C, Menier C. Early and intensive treadmill locomotor training for young children with cerebral palsy: A feasibility study. Pediatric Physical Therapy 1997; 9: 158-165.

Clinical Research - Head Injury

• Seif-Naraghi AH, Herman RM. A novel method for locomotion training. Journal of Head Trauma Rehabilitation 1999; 14: 146-162.