Friday, 16 March 2012

Treadmill and robotic-assisted training

Epub ahead of printDobkin & Duncan. Should Body Weight-Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate? Neurorehabil Neural Repair. 2012 Mar 12.  

Body weight-supported treadmill training (BWSTT) and robotic-assisted step training (RAST) have not, so far, led to better outcomes than a comparable dose of progressive over-ground training (OGT) for disabled persons with MS. The conceptual bases for these promising rehabilitation interventions had once seemed quite plausible, but the results of well-designed, randomized clinical trials have been disappointing. This paper reassess the underpinning concepts for BWSTT and RAST, which were derived from mammalian studies of treadmill-induced hind-limb stepping associated with central pattern generation (cortex) after low thoracic spinal cord transection, as well as human studies of the triple crown icons of task-oriented locomotor training, massed practice, and activity-induced neuroplasticity. The authors consider where theory and practice may have fallen short in the pilot studies that aimed to produce thoroughbred interventions. Based on these shortcomings, the authors move forward with recommendations for the future development of workhorse interventions for walking. In the absence of evidence for physical therapists to employ these strategies, however, BWSTT and RAST should not be provided routinely to disabled, vulnerable persons in place of OGT outside of a scientifically conducted efficacy trial.

"The authors are concluding that BWSTT and RAST do not have the evidence to support their use in MS rehabilitation and should only be provided in the context of a clinical trial. A similar stance to what I have taken in relation to CCSVI. It is unethical to expose MS'ers to expensive therapies that may not work or worse still cause harm."


"What do you think?"

4 comments:

  1. I've never heard of BWSTT and RAST.
    I hope it's ok to use the normal treadmills and cross-trainers found in gyms

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  2. Sometimes I think researches can forget that PwMS have actually got quite a lot of common sens and can figue out beneficial ways to exercise for themselves - or have I got that wrong?

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  3. Of course I meant common sense!

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  4. Re: "I've never heard of BWSTT and RAST. I hope it's ok to use the normal treadmills and cross-trainers found in gyms."

    BWSTT and RAST are for people who are too weak to walk; i.e. they need to be supported.

    It is fine to use treadmills and cross-trainers if you are mobile.

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