Body Weight Supported Treadmill
Training and Underwater Treadmill
Training
Gabriele Moriello morieg@sage.edu

By the end of this presentation, you should be able to:
 summarize findings from research to retrain running in those with TBI
 outline the differences between land and water treadmill training
 describe two intervention approaches used to retrain running in those with brain injury
 understand potential outcomes following completion of such programs

 Stance phase <50%, Swing phase >50%

↑ velocity

↓ time in stance
 No period of double support

↑ joint excursions and joint speed

↑ eccentric muscle strength
 Forward propulsion more dependent upon swing leg


↑ cadence with ↓ stride length

↓ self-selected speed

↓ stance time

↓ float phases

↑ BOS and lateral
COM displacement




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↑ knee flexion at initial contact
↑ knee extension at midstance
↑ knee flexion at push off
↓ ankle power generation at push off
↑ hip extensor power in early stance

http://www.epworth.org.au/Our-Services/rehabilitation/Pages/High-Level-Mobility-Running-Group.aspx
“The Running Group” (Epworth Hospital)
 Higher level mobility program to facilitate participation in social, leisure, sporting and employment roles
 High level mobility training (2x/week)
 General strength and cardiovascular fitness (3-
4x/week)


Program evaluation of “The Running
Group” (n=28)
 HiMAT scores increased from an average of
20.3 to 29.2
 No adverse events
Walking Walk backward
Walk on toes Walk over obstacle
Run Skipping
Hop forward (affected leg) Bound (more affected leg)
Bound (landing on less-affected leg) Up 14 stairs
Down 14 stairs

Biomechanical deviations are potentially associated with detrimental forces and balance impairments place people with TBI at higher risk for falls……..
Body Weight Supported Treadmill
Training (BWSTT)
Underwater Treadmill
Training (UWTT)

Body weight support
Reduction in ground reaction forces
Joint angles while running
BWSTT
Provides partial body weight support
Yes
Similar to land
Angular velocities while running
Postural control
Cardiovascular response
Thermal stress
Resistance
Sensory stimulation
11-22% less than land
YES
Same as land
No
No
UWTT
Provides partial body weight support
Yes
Different than BWSTT and land, especially at ankle and knee
35%-89% less than land
Yes
Increases function
Decreased
Yes
Yes

 Phase I (6 weeks)
 preparation for running
 Phase II (6 weeks)
 treadmill training using BWSTT or UWTT
 Phase III (3 weeks)
 carry over training

 Warm up (10 minutes)
 Balance training (15-20 minutes)
 Agility training (15-20 minutes)
 Core and extremity strengthening (15-20 minutes)
 Passive stretching

A. Walking or stationary bike
B. Dynamic stretching
Dynamic lunges
Hip pendulums

www.googleimages

First day of the week
Two speed trials
- 1 min-2 min-1 min
Warm Up
- 5 minute slow walk
Second day of the week
One distance trial
- at a self-selected speed
Cool down
- 5 minute slow walk
Over ground running

 Running over ground
 Return to sport activities/agility exercises

 Average age: late 20s
 5 female
 6 presented with left hemiplegia
 On average 5-6 years post-injury
 Ranchos Scale: ranged from 5-8
 All had impaired standing balance

BWSTT UWTT

UWTT

^
^MDC value >4
UWTT BWSTT
^
^
^

BWSTT
 Knee flexors
UWTT
 Hip extensors and abductors
 Ankle dorsiflexors and plantarflexors  Knee flexors and extensors
 Ankle plantarflexors

(↓ ankle dorsiflexors)

 People with brain injury CAN run/jog!!!!!
 Need intensity and repetition!!!!!!
 Plasticity (even years later)
 Importance of continued activity beyond traditional rehabilitation
 Important to monitor vital signs due to possible autonomic disruption (and they are most likely deconditioned)

 Remember this was a research protocol!
 It is very intense
 Physically
 Time
 Use the protocol as a basic guideline
 Individualize the program to your patient

 Matthew Frear
 Kristin Seaburg
 Michelle Haller
 Alexandra Adams
 Andrea Belanger
 Jeffrey Collins
 Dereck Silverman
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Alyssa Ingegni
Lydia Cable
Katie Stone
Matthew Van Slyke
Shi Feng Lin
Kaitlyn Kohlenberger
Erin Henderson

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Farley CT, Ferris DP. Biomechanics of walking and running: Center of mass movements to muscle action . 1998. Available at: http://www-personal.umich.edu/~ferrisdp/Farley&Ferris,1998.pdf .
Accessed 9/29/07.
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Neurology and Cardiovascular & Pulmonary Sections of the American Physical Therapy Association.
Exercise & physical activity guidelines based on best available evidence for individuals post stroke. Alexandria, VA: American Physical Therapy Association.
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