Body Weight–Supported Treadmill Training

The Importance of Gait Development

Developing effective walking ability is a key goal in the rehabilitation of patients with motor impairments, as walking is not only the primary form of human locomotion but also an essential prerequisite for successful social and everyday adaptation.

One of the promising approaches to gait development is body weight–supported treadmill training, which is increasingly used in adults and children with various neurological disorders.

During treadmill training sessions (with or without body weight support), the patient is able to perform a greater number of correct movements, which increases both the intensity and specificity of training for the required motor task. It has been shown that a patient after stroke can perform up to 1,000 steps during a 20-minute treadmill session, whereas during conventional physical rehabilitation exercises only 50–100 steps are typically performed [1]. Adequate training intensity is achieved through adjustment of treadmill speed, the level of body weight support, and appropriate assistance from the therapist.

Theoretical Basis of the Method

The theoretical foundation of this rehabilitation approach was established through the research of Barbeau H., who studied gait recovery in cats after complete spinal cord transection. After three months of body weight–supported treadmill training, walking ability was restored in these animals. Despite the absence of voluntary control over hind limb movements, the cats were able to walk with well-coordinated alternating stepping movements [2].

A new clinical strategy for gait training with body weight support was first introduced in 1980 [3]. This approach involved suspending the patient above a treadmill to reduce the load on the lower limbs and facilitate walking in individuals with neurological impairments. As gait skills improved, the amount of body weight support was gradually reduced.

Since then, body weight–supported treadmill training has been increasingly used for gait rehabilitation after stroke. A Cochrane review analyzing data from 15 studies involving 622 participants supports the use of this rehabilitation method, while also emphasizing that existing studies are insufficient and further research is required [4].

Application in Cerebral Palsy

In recent years, body weight–supported treadmill training has been applied to gait development in children with cerebral palsy. An increasing number of studies indicate that the human central nervous system retains a substantial capacity for functional recovery after injury, provided that appropriate rehabilitation is prescribed. Specifically, targeted and task-specific training such as body weight–supported treadmill training is considered a promising approach for helping patients acquire independent walking skills [5].

Clinical Research Data

At the Wilhelminen Hospital in Vienna, the potential role of body weight–supported treadmill training was studied in a group of 10 children with cerebral palsy, six of whom were non-ambulatory. In addition to standard rehabilitation, the children trained on a treadmill for 25 minutes, three times per week, over a three-month period. The study demonstrated significant improvements in mobility in all participants [6].

In Kansas (USA), the effectiveness of combining traditional intensive physical rehabilitation with body weight–supported treadmill training was investigated [7]. Over a four-week period, five children with spastic forms of cerebral palsy participated in training sessions three to four times per week, each lasting two hours. Outcomes were assessed using the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI), pedography, and the 10-meter walking test. All five children demonstrated significant improvements in motor skills and mobility.

At the University of New Mexico, changes in endurance, functional gait parameters, and balance were evaluated following an intensive treadmill training program with body weight support [8]. Six ambulatory school-aged children with cerebral palsy trained twice daily for 30 minutes over a two-week period. Statistically significant improvements in endurance and functional gait parameters were observed in four of the six participants.

A controlled clinical study conducted at La Trobe University in Australia involved 14 children with cerebral palsy. In the experimental group, treadmill training was conducted at school twice per week for 1.5 months. Compared to the control group, children who participated in treadmill training demonstrated significant improvements in walking speed and endurance [9].

Treadmill training is important not only for gait development but also for maintaining physical condition in adults with cerebral palsy. According to data reported by Jansen R., deterioration of walking ability occurs before the age of 35 in 44% of adults with cerebral palsy [10]. To prevent declines in endurance and physical strength, ambulatory adults with cerebral palsy should be involved in regular training programs that include body weight–supported treadmill training.

Most authors agree that treadmill training is a promising rehabilitation approach and that further research is needed to define clear indications, optimal training intensity and duration, and criteria for evaluating effectiveness in patients with cerebral palsy.

Experience in the Kozyavkin Method

Considering positive international experience, body weight–supported gait training has been incorporated into the integrated system of intensive neurorehabilitation according to the Kozyavkin Method [11].

Gait training within this rehabilitation system consists of three main components:

1. gait training on a treadmill;
2. gait training on a stationary surface;
3. walking in everyday conditions with minimal use of assistive devices.

The objective of treadmill training is to teach the patient to perform stepping movements using the brain’s capacity to learn and generate appropriate neural impulses to the leg muscles in response to correct sensory stimuli. Sensory signals generated during stepping movements are necessary for forming the locomotor pattern. Initial gait learning occurs primarily during treadmill training, as the nervous system forms movement patterns associated with walking.

After treadmill gait training, patients transition to walking on a stationary surface. The purpose of this stage is to transfer the skills acquired on the treadmill to overground walking. Gait deficits identified during overground walking are subsequently corrected during further treadmill training.

The most important component is gait training in everyday conditions. The goal is to transfer treadmill-acquired skills to safe ambulation in real-life environments. The physician selects assistive devices that provide the necessary safety while minimally restricting the patient’s independence.

Principles of the Training Program

Treadmill training with body weight support is provided to patients who are unable to walk independently. Ambulatory children receive gait correction using a standard electric treadmill. Training sessions are conducted by physical therapy instructors who have undergone specialized training.

Before initiating training, the instructor evaluates gait impairments through visual analysis. Based on the physician’s goals, diagnosis, and patient condition, an individualized training program is developed. Typically, the total number of sessions is 10, with an average duration of 10–15 minutes per session. Training intensity is moderate during the first two days, gradually increases over the next seven days, and decreases during the final two days. Exercise load is monitored by heart rate.

In addition to step pattern training, programs often include exercises for weight transfer, step symmetry, rhythm (using counting or music), side stepping, and backward walking. Gradually, the level of body weight support and manual assistance is reduced.

Progress in gait training is assessed across five key domains: body weight support, speed, independence, endurance, and gait kinematics [12].

Required Equipment

Treadmill training requires appropriate equipment, including a treadmill, a body weight support system, and a patient suspension system. Without adequate equipment, this method of gait training in patients with cerebral palsy may be ineffective or even unsafe.

The treadmill must operate at low speeds with small incremental adjustments. The length and width of the treadmill surface must allow safe stepping and therapist access. Handrails, speed display, emergency stop, and wheelchair access ramps are important features. Adequate space on both sides of the treadmill is required for the instructor.

The body weight support system reduces load on the lower limbs and prevents injury in the event of a fall. It must allow sufficient vertical displacement of the body’s center of mass (approximately 5 cm) for normal gait while maintaining stability.

The suspension harness should support the chest, hips, and pelvis while allowing free movement of the arms and legs. It must be properly fitted, comfortable, easy to don and remove, and ensure upright posture.

At the International Rehabilitation Clinic, gait training is performed using the LOKO Station PPS 55 (Woodway) body weight–supported treadmill, which meets all technical and safety requirements.

Summary

Body weight–supported treadmill training is a promising approach for gait development and rehabilitation. Scientific evidence supports its use, although existing studies are not sufficient and further research is required. Considering positive international experience, this method has been integrated into the intensive neurorehabilitation system according to the Kozyavkin Method.
The success of treadmill training depends on accurate adherence to training protocols, the availability of qualified instructors, and appropriate equipment.ctiveness criteria.
The success of treadmill training depends on strict adherence to training protocols, the availability of qualified specialists, and appropriate equipment.

References

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2. Barbeau H, Rossignol S. Recovery of locomotion after chronic spinalization in the adult cat. // Brain Research.- 1987.- 412.- P.84–95.
3. Finch L, Barbeau H. Hemiplegic gait: new treatment strategies. // Physiotherapy Canada.- 1985.- 38.- P.36–41.
4. Moseley A.M., Stark A, Cameron I.D., Pollock A. Treadmill training and body weight support for walking after stroke (Review) // Cochrane Database of Systematic Reviews.- 2003.- Issue 3. Art. No.: CD002840. DOI: 10.1002/14651858.CD002840.pub2.
5. Aisen M. Body weight supported treadmill training in children with CP. August Fact Sheet. // United Cerebral Palsy – elektronnyi resurs dostupnyi za adresoiu:
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   Tsytovano 5 liutoho 2008.
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8. Provost B., Dieruf K., Burtner P.A., Phillips J.P., Bernitsky-Beddingfield A., Sullivan K.J., Bowen C.A., Toser L. Endurance and gait in children with cerebral palsy after intensive body weight-supported treadmill training. // Pediatr Phys Ther.- 2007.- 19(1).- P.2–10.
9. Dodd K.J., Foley S. Partial body-weight supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial. // Dev Med Child Neurol.- 2007.- 49(2).- P.101–105.
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11. Koziavkyn V.I., Sak N.N., Kachmar O.A., Babadahly M.A. Osnovy reabilitatsii rukhovykh porushen po metodu Koziavkyna.- Lviv: Ukrainski Tekhnolohii, 2007.- 192 s.
12. Harkema S., Behrman A. Locomotor Training: Principles and Practice // Dejong G. (ed.). Robomedica, Inc., Los Angeles, 2002.

About the author

Halyna Lun

Deputy Director of the Elita Rehabilitation Center, pediatrician, and mentor with over 30 years of practice. She leads the medical department, consults families, and trains future doctors.