Walking Reeducation with Partial Relief of Body Weight in Rehabilitation of Patients with Locomotor Disabilities

Thomas Pillar, MD; Ruth Dickstein, DSc; Zvi Smolinski, MSc

Summary by Patty Davis, MS, Mobility Research, 20 March 1997

Walking is one of the most fundamental motor tasks required for the completion of many of the daily activities of life. Locomotor impairments are often manifested in the inability of the affected limb to accept and bear weight, and conversely, transfer weight bearing load to facilitate ambulation. Currently, the primary compensatory aids are canes, walkers and/or any other device which allows ambulation at a decreased weight bearing load. It was, therefore, the purpose of this study to develop and test a partial weight bearing (PWB) protocol which facilitates ambulation for those individuals with locomotor impairments.

The primary test group for the study was composed of 24 subjects ranging in age from 42-84 years. The subjects had varying conditions and impairment levels upon entry into the study, including the following: 1) hemiplegia; 2) spinal cord injury; and 3) below knee amputation. The secondary test group was composed of six apparently healthy subjects, ranging in age from 25-50 years. The secondary group was used as a control group, testing the effects of the partial weight bearing protocol on the locomotion of healthy individuals.

The "weight-relieving system" consisted of a harness mounted from the ceiling, which positioned the subject over parallel bars. The system allowed for the adjustment of the weight bearing load (0-150 kgs), while keeping the extremities free to move in normal gait patterns. Data was collected for the timing of the stance and swing phases, allowing for the calculation of gait symmetry and gait velocity. Video analysis allowed for a frame by frame breakdown of gait patterns. Also included in the data collection was a subjective evaluation of gait by both the subject and the investigator. Data was collected in each of the following 3 trials: 1) free ambulation; 2) ambulation while hooked up to the weight relief system, but experiencing a 0% reduction in weight bearing load; and 3) ambulation with a 20% reduction in the weight bearing load.

The results of this investigation are in agreement with earlier PWB research, finding that ambulation was improved with the PWB protocol. Stance time on the unaffected limb was reduced, while load bearing on the affected limb was increased, gait velocity increased, and gait symmetry was improved during the partial weight bearing trials. In addition, those subjects who were non-ambulatory prior to the investigation, were able to stand and walk in the "weight-relieving system". The therapists involved in the investigation found that they were more able to focus on the manual manipulation of affected limbs, facilitating greater improvements in gait patterns. Analysis of the data of the apparently healthy subjects, however, found a decrease in gait velocity. This decrease in velocity was attributed to the upper trunk restrictions imposed by the harness. The harness system seemed to inhibit the natural "forward fall" of the head, arms and trunk seen in normal gait. It was thought however, that the disabled patients were much less affected by this restriction, thus accounting for the increases in gait velocity seen in the primary test group.

This study supports the current theory that PWB protocols can have a positive impact on the rehabilitation of a very wide range of disabled patients. The PWB protocol provided an environment free of potential falls, allowing the therapist to focus on gait training corrections. Furthermore, PWB provides for a progressive increase in the weight bearing load, allowing each rehabilitation session to be adapted to the individual needs of the patient. The patient can then be gradually reintroduced to full weight bearing loads, while continuing to develop proper gait patterns. PWB gait therapy has the potential to have a tremendous impact on gait, balance and coordination rehabilitation for even the most severely involved patients. In addition protocols designed to facilitate changes in muscular strength, cardiovascular endurance, as well as fall prevention can now be started much earlier in the recovery process. PWB gait therapy is a promising new technique emerging on the rehabilitation front. Much research is, however, needed to realize the true potential of PWB gait therapy.