Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
J Neuroeng Rehabil. 2024 Jun 7;21(1):97. doi: 10.1186/s12984-024-01389-8.
Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses.
A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles.
Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies.
Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
体重支持（BWS）训练设备常用于改善神经功能障碍个体的步态，但在选择适当的 BWS 水平方面的指导有限。在这里，我们旨在描述在步态训练中使用的初始 BWS 水平、选择该水平的原理以及与 BWS 训练相关的临床目标，这些目标针对不同的诊断。
在 PubMed、Embase 和 Web of Science 中进行了系统的文献检索，检索词包括人群（神经障碍个体）、干预（BWS 训练）和结局（步态）。从纳入的文章中提取患者特征、BWS 设备类型、BWS 水平和训练目标的信息。
共纳入 33 篇文章，描述了基于框架（固定或移动）和单向天花板悬挂设备的四种诊断（多发性硬化症（MS）、脊髓损伤（SCI）、中风、创伤性脑损伤（TBI））的结果。MS 患者的 BWS 水平最高（中位数：75%，IQR：6%），其次是 SCI（中位数：40%，IQR：35%）、中风（中位数：30%，IQR：4.75%）和 TBI（中位数：15%，IQR：0%）。纳入的研究报告了十一个不同的训练目标。大多数训练目标的报道 BWS 水平在 30%至 75%之间，BWS 水平、诊断、训练目标和 BWS 选择的原理之间没有明确的关系。所有纳入的研究都达到了训练目标。
本综述纳入的研究之间初始 BWS 水平差异较大。纳入研究中，这些差异的基本原理并没有得到明确的说明。研究设计和人群的差异不允许得出关于 BWS 水平有效性的结论。因此，很难为不同诊断、BWS 设备和训练目标制定最佳 BWS 设置的指南。需要进一步努力制定临床指南，并通过实验研究确定哪些初始 BWS 水平对特定的诊断和训练目标是最佳的。
