Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate?

Bruce H. Dobkin*, Pamela W. Duncan

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

149 Citations (Scopus)

Abstract

Body weight-supported treadmill training (BWSTT) and robotic-assisted step training (RAST) have not, so far, led to better outcomes than a comparable dose of progressive over-ground training (OGT) for disabled persons with stroke, spinal cord injury, multiple sclerosis, Parkinson's disease, or cerebral palsy. The conceptual bases for these promising rehabilitation interventions had once seemed quite plausible, but the results of well-designed, randomized clinical trials have been disappointing. The authors reassess the underpinning concepts for BWSTT and RAST, which were derived from mammalian studies of treadmill-induced hind-limb stepping associated with central pattern generation after low thoracic spinal cord transection, as well as human studies of the triple crown icons of task-oriented locomotor training, massed practice, and activity-induced neuroplasticity. The authors retrospectively consider where theory and practice may have fallen short in the pilot studies that aimed to produce thoroughbred interventions. Based on these shortcomings, the authors move forward with recommendations for the future development of workhorse interventions for walking. In the absence of evidence for physical therapists to employ these strategies, however, BWSTT and RAST should not be provided routinely to disabled, vulnerable persons in place of OGT outside of a scientifically conducted efficacy trial.

Original languageEnglish
Pages (from-to)308-317
Number of pages10
JournalNeurorehabilitation and Neural Repair
Volume26
Issue number4
DOIs
Publication statusPublished - May 2012
Externally publishedYes

Keywords

  • central pattern generators
  • clinical trials
  • exercise therapy
  • locomotion
  • motor activity
  • physical therapy modalities
  • robotics
  • spinal cord injury rehabilitation
  • stroke rehabilitation
  • walking

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