THERAPY-Magazin
The gait lab
The innovative gait lab system enables stroke patients to improve walking ability with up to 250% more therapy intensity. Based on evidence-based guidelines and high patient acceptance, the device-supported approach boosts mobility and recovery outcomes.
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THERAPY Magazin
Innovative gait rehabilitation in neurology
Problem
In Germany alone, approximately 262,000 people suffer a stroke every year. 70% of patients who have suffered a stroke have considerable restricted mobility and 20% are wheelchair-dependent for life. Mobilising patients with high-grade palsy requires high-frequency and intensive physiotherapy, particularly in the first three to six months.
When it comes to ensuring optimal rehabilitation outcomes in line with the recommended guidelines, gait rehabilitation often falls short against the full round of physiotherapy tasks. Scientifically recommended intensities cannot be achieved with conventional physiotherapy for acquired brain injury. As a well-founded solution, Buschfort et al. developed a gait lab (GL) in 2016. This is a unique therapy system that enables poststroke patients to train in a customised, device-based group setting.
In Germany alone, approximately 262,000 people suffer a stroke every year. 70% of patients who have suffered a stroke have considerable restricted mobility and 20% are wheelchair-dependent for life. Mobilising patients with high-grade palsy requires high-frequency and intensive physiotherapy, particularly in the first three to six months.
When it comes to ensuring optimal rehabilitation outcomes in line with the recommended guidelines, gait rehabilitation often falls short against the full round of physiotherapy tasks. Scientifically recommended intensities cannot be achieved with conventional physiotherapy for acquired brain injury. As a well-founded solution, Buschfort et al. developed a gait lab (GL) in 2016. This is a unique therapy system that enables poststroke patients to train in a customised, device-based group setting.
Method
The gait lab consists of four training stations. At the same time, up to five patients train three to five times a week at the different stations and are instructed by two physiotherapists. In combination with conventional physiotherapeutic individual therapy, this makes it possible to increase the therapeutic intensity of gait training by up to 250%. This means that gait rehabilitation meets the requirements as recommended in the ReMoS S2e guideline. Most of the therapy recommendations in the guideline are an integral part of the gait lab design (see table). In addition, a treatment algorithm, in the sense of an electronic exercise catalogue, was derived from this guideline in order to ensure high-quality, effective and evidence-based training for each patient at the appropriate performance level.
The first exercise station – a computer-assisted balance trainer – offers patients the chance to do weight shifts and targeted leg training. This device also has a biofeedback function for training with an external focus.
The second element of the concept is a type LYRA gait trainer. This is an end-effector-based device that enables patients to train with partial or complete body weight support. Patients who have not been able to walk independently benefit from repetition and the high number of steps for motor learning. Patients who are unable to walk experience an optimal learning condition with a daily number of 500 steps during a 30-minute training session on the gait trainer.
Treadmill training is the third station in the gait lab. It focuses on developing walking distance and speed, as this is what the guideline recommends as a focal point at this stage of therapy.
The last element is the Easy-Walk-System. Up to four patients can practise the Easy-Walk at the same time. A special belt suspension along an oval track (20 m walking distance) enables gait or balance training in a secure setting.
In physiotherapeutic diagnostics, standardised assessments are used to determine the severity of mobility impairment and to set a goal for therapy in the gait lab. Patients are allocated to the individual training stations in the gait lab based on the key target and the recommendations of the ReMoS S2e guideline. The patient’s training profile, including all exercise modalities, stems from the specially designed electronic exercise catalogue complete with filter function. The exercise catalogue is used for continually shaping therapy content in the gait lab to the underlying evidence and for ensuring consistent therapy quality.
At least one training station in the gait lab corresponds to each performance level on the way to achieving walking ability. Patients develop and enhance basic walking functions in a systematic sequence that “step by step” lead to everyday mobility.
The gait lab consists of four training stations. At the same time, up to five patients train three to five times a week at the different stations and are instructed by two physiotherapists. In combination with conventional physiotherapeutic individual therapy, this makes it possible to increase the therapeutic intensity of gait training by up to 250%. This means that gait rehabilitation meets the requirements as recommended in the ReMoS S2e guideline. Most of the therapy recommendations in the guideline are an integral part of the gait lab design (see table). In addition, a treatment algorithm, in the sense of an electronic exercise catalogue, was derived from this guideline in order to ensure high-quality, effective and evidence-based training for each patient at the appropriate performance level.
The first exercise station – a computer-assisted balance trainer – offers patients the chance to do weight shifts and targeted leg training. This device also has a biofeedback function for training with an external focus.
The second element of the concept is a type LYRA gait trainer. This is an end-effector-based device that enables patients to train with partial or complete body weight support. Patients who have not been able to walk independently benefit from repetition and the high number of steps for motor learning. Patients who are unable to walk experience an optimal learning condition with a daily number of 500 steps during a 30-minute training session on the gait trainer.
Treadmill training is the third station in the gait lab. It focuses on developing walking distance and speed, as this is what the guideline recommends as a focal point at this stage of therapy.
The last element is the Easy-Walk-System. Up to four patients can practise the Easy-Walk at the same time. A special belt suspension along an oval track (20 m walking distance) enables gait or balance training in a secure setting.
In physiotherapeutic diagnostics, standardised assessments are used to determine the severity of mobility impairment and to set a goal for therapy in the gait lab. Patients are allocated to the individual training stations in the gait lab based on the key target and the recommendations of the ReMoS S2e guideline. The patient’s training profile, including all exercise modalities, stems from the specially designed electronic exercise catalogue complete with filter function. The exercise catalogue is used for continually shaping therapy content in the gait lab to the underlying evidence and for ensuring consistent therapy quality.
At least one training station in the gait lab corresponds to each performance level on the way to achieving walking ability. Patients develop and enhance basic walking functions in a systematic sequence that “step by step” lead to everyday mobility.
Initial results
A randomised and controlled pilot study presents initial results on the practicability of the gait lab in everyday clinical practice and on the efficacy of walking ability among the study participants. Compared to the control group, the results show significant improvements in the intervention group’s walking ability.
Given that walking, paired with independence, is a central goal of almost all neurological patients, the gait lab has a high level of acceptance in the therapy process. In terms of developing basic walking abilities, intensive training in the gait lab shows clear and particularly stable effects, making it a highly attractive solution for users across all phases of neurorehabilitation.
A randomised and controlled pilot study presents initial results on the practicability of the gait lab in everyday clinical practice and on the efficacy of walking ability among the study participants. Compared to the control group, the results show significant improvements in the intervention group’s walking ability.
Given that walking, paired with independence, is a central goal of almost all neurological patients, the gait lab has a high level of acceptance in the therapy process. In terms of developing basic walking abilities, intensive training in the gait lab shows clear and particularly stable effects, making it a highly attractive solution for users across all phases of neurorehabilitation.
Ambulante Rehabilitation
balo
coro
Fachkreise
Gait
lyra
Produkte
Standing & Balancing
Stationäre Rehabilitation
Therapy & Practice
THERAPY 2018-II
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THERAPY Magazin
References:
- Braun, T., Marks, D., Thiel, Ch., Zietz, D., Zutter, D., Grüneberg, Ch. (2015). Auswirkungen von zusätzlichem, dynamisch unterstütztem Stehtraining auf die funktionelle Erholung bei Patienten mit subakutem Schlaganfall: eine randomisierte Pilot und Machbarkeitsstudie. Clin Rehab, 7.
- Dohle, Ch., Quintern, J., Saal, S., Stephan, K.M., Tholen, R., Wittenberg, H. (2015). S2eLeitlinie Rehabilitation der Mobilität nach Schlaganfall (ReMoS). Neurol & Rehab. 7, 3567.
- Peurala, S. H., Airaksinen, O., Huuskonen, P., Jäkälä, P., Juhakoski, M., Sandell, K., Tarkka, I.M., Sivenius, J. (2009). Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. Rehabil Med. 41, 16673
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