The impact of body weight-supported systems on patients with neurological conditions.

1. ody weight-supported (BWS)
track and treadmill systems are
carving out an important niche
in the treatment of patients with
a variety of neurological and related condi-
tions. As the technology is implemented at
facilities across the country, PT profes-
sionals are learning all the ways it can
benefit their populations.
Sandra Burns, PT, DPT, c/NDT,
a staff therapist at Mercy Medical
Center in Sioux City, Iowa, pri-
marily focuses on pediatrics,
with additional interest and
experience in adult neuro-
logical treatment. She told
ADVANCE about the body
weight-supported technology
in use at her facility.
“We have three different systems at Mercy
Medical Center,” she said. “One is a mobile
adult system that can be utilized over ground
or over a treadmill. We find this system use-
ful in acute care as well as on the acute rehab
unit. We also have a stationary over-tread-
mill unit that accommodates adults and
older children, typically age 10 and up. This
unit can be used for bariatric patients if need
be as well. Our newest addition is a pediatric
body weight-supported unit, which can be
used over ground or over the treadmill, in
outpatient or acute care.”
Treatment Insight
Burns has utilized the various units with a
number of different patients experiencing
neurological impairments.
GAIT & BALANCE
Supporting
Steps
The impact of body
weight-supported
systems on patients with
neurological conditions
By Brian W. Ferrie
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Wendy Norelli, PT, PMA-CPT, treats patient Vanessa
Gearhart with the help of a body weight-supported
harness system at Good Shepherd Rehabilitation
Hospital in Allentown, Penn.
11 ADVANCE for Physical Therapy & Rehab Medicine May 4, 2015 www.advanceweb.com/pt
COURTESYGOODSHEPHERDREHABILITATIONNETWORK

2. “Typically, I’m working toward gait with children when using the
pediatric walker system,” she explained. “However, I’ll also use the sys-
tem for weight-bearing activities, learning to weight-shift, kick and even
catch in a safe, supported environment. In addition, I’ve used it when
working on four-point and creeping, bouncing, jumping and running
skills. The system is an excellent option when I need to have my hands
free to facilitate the appropriate muscle recruitment.”
How do her patients typically react to weight-bearing apparatus?
“The majority of the children are receptive,” Burns related. “They
enjoy the freedom of mobility and ability to complete tasks by them-
selves, so to speak. Families are reassured their children are well-sup-
ported during therapy, especially when the kids are larger or very
low-tone. Some children have sensory issues, requiring that some pre-
paratory work be completed before use of the harness system.”
Furthermore, the treatment has definitely proven effective in
Burns’ experience.
“Research supports the use of body weight-supported training for
the acquisition of gait skills,” she noted. “From an observational stand-
point, I can report profound gains in mobility skills, benefits from
weight-bearing, improved ability to fractionate and isolate movements,
as well as initiate movements spontaneously.”
Meanwhile on the East Coast, Good Shepherd Rehabilitation
Hospital, Allentown, Penn., has experienced similar success.
“We see patients here with stroke, spinal cord injury, head injury, ves-
tibular issues, concussion, multiple sclerosis, cancer, Parkinson’s, move-
ment disorders, really anything neurologic, as well as amputations,”
said Sue Golden, PT, NCS, director of neurorehabilitation therapies.
The facility implemented a body weight-supported system in
December and saw immediate positive results.
“All of the programs that we develop here are based on neuroplas-
ticity,” Golden explained. “We feel if you attack function from all
angles, you give a person the best chance of recovery, no matter what
that recovery might be.”
The system at Good Shepherd includes a track and harness.
“You can determine how much weight you’re going to take off
patients, as well as specify if you only want them to move in a certain
parameter, for example to work on side-stepping or weight-shifting.
Or you can open up the entire track and allow people to walk with
11 ADVANCE for Physical Therapy & Rehab Medicine May 4, 2015 www.advanceweb.com/pt
GAIT & BALANCE
Overall, both Burns and Golden provided nothing but positive
feedback about utilizing body weight-supported equipment for therapy.

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May 4, 2015 ADVANCE for Physical Therapy & Rehab Medicine 11
or without a device. Again, we’re looking at the challenge of balance,
proprioception, integrating vision, and the alignment for gait.”
The apparatus can be used for patients with stroke at lower or higher
levels of function, added Golden.
“You can work the core through lunges, treat patients with ampu-
tations, take a patient with incomplete spinal cord injury either with
braces or without braces who might be starting a motor-control pro-
gram. You can pre-gait, emphasizing sit-to-stand, and really focus on
helping a patient become weight-bearing through an affected leg.”
Patient Progress
Just before speaking with ADVANCE, Golden utilized the apparatus
with a fairly severe stroke patient who tends to push frequently.
“We were able to take away his assis-
tive device because he wasn’t likely to
fall, and we only allowed the tether
to go a certain length so it would
catch him if he did,” she said. “So
he started taking steps while holding
my hand and receiving directions on
weight-shifting. He really began to
trust his affected leg and walked the
most he has since his stroke.”
Golden also recalled the success of
the first patient who the therapy staff
at Good Shepherd placed in the body
weight-supported equipment.
“She’s in her early 20s and a couple
years removed from sustaining her head injury. Since the accident, she
hadn’t been able to stand on one foot. But within a couple minutes
on this apparatus, she did and was just all giggles and smiles, saying
‘I can’t believe I can do this!’”
Treatment sessions at Good Shepherd typically last an hour, with
about 45 minutes spent in the body weight-supported apparatus.
“If patients need to sit down intermittently, we’ll have them do that
in the harness,” Golden related. “And mind you, neither therapist was
sweating today while we worked with the stroke patient. That was
amazing, because I treated this man once by myself without the body
weight-supported equipment, and I was definitely perspiring.”
Overall, both Burns and Golden provided nothing but positive feed-
back about utilizing body weight-supported equipment for therapy.
“These BWS units have augmented my ability to progress patients
immensely,” said Burns. “They’ve also saved my body significant wear
and tear. I’d recommend these units to any therapist who works with
patients dealing with mobility issues. They provide a safe, supportive
environment to progress patients to the next level of mobility.”
“I think the equipment has been a wonderful addition,” Golden
added. “We’re trying to promote function through every avenue,
at every level for every person, while keeping them safe. To really
increase their repetitions of being upright and moving. I believe this
equipment is a great complement to our treatment, another tool in
our toolbox to help people.” n
Brian W. Ferrie is on staff at ADVANCE. Contact: bferrie@advance
web.com
Online
For more stroke-
related content visit
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com/ptgeriatrics