The importance of the trunk in neurological gait rehabilitation: the influence of walking speed, body
weight support and robot assistance
dra. Eva Swinnen1, prof. dr. Eric Kerckhofs1, prof. dr. Jean-Pierre Baeyens2
1Vrije
Universiteit Brussel, Faculty of physical education and physiotherapy, Physiotherapy, Rehabilitation Research, 2Vrije
Unversiteit Brussel, Faculty of physical education and physiotherapy, Biometry and Biomechanics
Background: Robot-assisted (RA) gait rehabilitation has been reported to improve gait- and balance
related outcome measures, but it is not proven that gait rehabilitation robots are superior compared to
other gait rehabilitation methods [1-3]. Although the trunk and pelvis are important to maintain balance
during gait, less attention has been spent to trunk and pelvis during walking. It is possible that a
restriction in the trunk and pelvis movements during RA walking with the use of body weight support
(BWS) leads to an insufficient training of the trunk balance. Methods: Kinematic and EMG data of the
trunk and pelvis [4] were collected during (1) walking on a treadmill at different speeds (older and
younger healthy participants), (2) walking on a treadmill with different levels of BWS (persons with MS
and healthy participants) and (3) RA treadmill walking with the Lokomat-system (healthy participants).
Results: In general (1) when walking slower than normal the trunk muscles were less active and the
movements of the trunk and pelvis changed significantly [5]; (2) with increasing percentages of BWS
there was an increase in abdominal muscle activity, a decrease in back muscle activity and a significant
change of trunk and pelvis movements compared with walking without BWS, and (3) during RA treadmill
walking with the use of BWS, significant differences in trunk and pelvis kinematics were found compared
with walking without RA. Conclusion: It can be concluded that walking at a low speed, with high
amounts of BWS or with RA leads to significant changes in trunk muscle activity and trunk and pelvis
movements. It is probable that these differences influence training of the trunk balance during gait
rehabilitation. The results of the current studies should be taken into account in developing gait
rehabilitation robots and in gait rehabilitation itself.
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