Which devices are available to deliver mechanically assisted walking training with body weight support?

In our review (here), we identified three main categories of devices: treadmills with a harness, movable footplates with a harness (such as a gait trainer) and orthoses (ie, Lokomat, WeWALK and ExoAtlet).

Each device has different advantages. For example, a treadmill with a harness is the least expensive option, whereas orthoses are expensive but require less physical effort by the therapist.

In general, therapists should consider three aspects of mechanically assisted walking training with body weight support when choosing a device: the walking surface (overground, treadmill or footplates), the provision of body weight support (harness or orthosis) and the movement of the legs (patient/therapist-assisted or mechanical/automated).

In the trials you reviewed, what was the mechanically assisted walking compared with?

Researchers compared mechanically assisted walking training with usual walking training (ie, overground walking).

This control condition sometimes included preparatory exercises and various forms of assistance (eg, support from therapist(s) or the use of aids like walking sticks).

In terms of short-term outcomes, how did mechanically assisted walking training stack up against usual walking training?

In the short term, after a month of intervention, mechanically assisted walking led to more independent walking and better walking ability compared to usual walking training.

We observed that participants who received mechanically assisted walking training were able to achieve independent walking 19 per cent more often than the control group.

The experimental group also improved their walking ability by 0.8 points out of five on the Functional Ambulation Category compared to those in the control group.

What about longer-term outcomes?

In the longer term, our results are less certain.

Although the results are similar to those in the short term, the findings are not precise enough to confirm a longer-term benefit of mechanically assisted walking because fewer than half the studies measured this specifically.

What about the issue of walking speed, which concerns some therapists? Was there any detriment in walking speed?

Some therapists are hesitant to use mechanical assistance for individuals after a stroke because they fear it could be detrimental to walking.

Because walking speed is a good measure of overall walking after stroke, we looked into how it is affected by mechanically assisted walking.

Our findings demonstrated that mechanically assisted walking training is not detrimental to walking speed in the short or long term.

What are some priorities for further research in this field?

The exact long-term effect of mechanically assisted walking training can only be determined with further trials.

Given that independent walking is essential for patients to be able to return home, therapists should be encouraged to use this intervention in subacute non-ambulatory stroke patients.

We think future studies should focus on implementation.

>>Dr Louise Ada APAM is an emeritus professor at the University of Sydney who has spent her career both teaching and researching. Her research has been mainly focused on rehabilitation after stroke.