Body-Weight Supported Treadmill Training (BWSTT)
It has been more than 20 years since it was first demonstrated that BWSTT in animals can enhance locomotor activity after spinal cord transection (Edgerton et al. 1991; Barbeau and Rossignol 1987). In this approach, partial body weight support is provided by a harness suspended from the ceiling or a frame while limb stepping movements are assisted by a moving treadmill belt. In the ensuing years, BWSTT strategies have been introduced as a promising approach to improve ambulatory function in people with SCI (Barbeau and Blunt 1991), raising much excitement and interest among rehabilitation specialists and neuroscientists.
In this review, we focus on the BWSTT intervention studies that report functional ambulation outcome measures (such as walking speed or endurance). These studies tend to focus on individuals with incomplete SCI lesions as the recovery of overground functional ambulation has not been shown in people with clinically complete spinal lesions (Waters et al. 1992). Although modulation of muscle (EMG) activity during body weight support treadmill-assisted stepping in individuals with complete SCI lesions has been shown (Dietz and Muller 2004; Grasso et al. 2004; Wirz et al. 2001; Dietz et al. 1998; Wernig et al. 1995; Dietz et al. 1995; Faist et al. 1994), there has not been any evidence for functional ambulatory gains in this sub-population.
- There is level 2 (Alcobendas-Maestro et al. 2012) and level 3 evidence (Wernig et al. 1995) using historical controls that BWSTT is effective in improving ambulatory function. However, two level 2 RCTs (Dobkin et al. 2006;Hornby et al. 2005a) demonstrates that BWSTT has equivalent effects to conventional rehabilitation consisting of an equivalent amount of overground mobility practice for gait outcomes in acute/sub-acute SCI.
- For patients less than 12 months post-SCI, BWSTT may have similar effects on gait outcomes as overground mobility training of similar intensity.