Improving gait in multiple sclerosis using robot-assisted, body weight supported treadmill training.
BACKGROUND
The majority of patients with multiple sclerosis (MS) develop progressive gait impairment, which can start early in the disease and worsen over a lifetime. A promising outpatient intervention to help improve gait function with potential for addressing this treatment gap is task-repetitive gait training.


METHODS
Body weight supported treadmill training (BWSTT) with or without robotic assistance (Lokomat) was tested using a randomized crossover design in 13 patients with relapsing-remitting, secondary progressive or primary progressive MS. Patients received 6 training sessions over 3 weeks of each intervention. Outcomes included changes in the timed 25-foot walk (T25FW), the 6-minute walk treadmill test (6MW) distance, the Kurtzke Expanded Disability Status Scale (EDSS), as well as double-limb support time and step length ratio.


RESULTS
There were no major differences in outcomes between treatment groups. The study population significantly improved on gait outcomes and the EDSS following BWSTT, including a 31% improvement in the T25FW, a 38.5% improvement in the 6MW, and a 1-point gain for the EDSS. Differences in pre/post changes were noted depending on gender, disease subtype, affected limb, and baseline EDSS.


CONCLUSIONS
Although no differences in gait outcomes or the EDSS were found between treatment groups, this small pilot study of task-repetitive gait training resulted in significant within-subject improvements. BWSTT appears to be an activity-dependent intervention with potential to reduce gait impairment in MS.
Lo
Albert C
AC
Department of Clinical Neurosciences at Brown University, Providence VA Medical Center, Providence, Rhode Island 02909-4799, USA. albert_lo@brown.edu
Triche
Elizabeth W
EW
D000328:Adult; D001835:Body Weight / Q000502:physiology; D004185:Disability Evaluation; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods*; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000534:rehabilitation; D010865:Pilot Projects; D012371:Robotics; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology*