Last Updated Nov 2011
Body Weight Supported Gait Training (BWSGT or supported gait), which involves the suspension of a patient over the ground or a treadmill using a harness system, has become increasingly popular in the clinical therapy setting in place of traditional gait training. In fact, many patients who may not be able to train otherwise can benefit from training in a harness—including patients who are excessively heavy, overly dependent, or those with severe balance disorders.
Stroke patients, for example, have seen significant benefits with BWSGT and are probably the most studied patient population. A large amount of research has also been completed on patients with spinal cord injuries, and most studies have found BWSGT to be comparable to over-ground training. Individuals with Parkinson’s disease have also been able to increase gait speed as well as step length after BWSGT, and studies show results were maintained even after treatment was discontinued.
BWSGT Basics: The Harness
With BWSGT, the purpose of the harness is to provide stability and to unweight (or reduce pressure on) the lower limbs to allow easier walking. When speaking of unweighting, it is generally referred to in terms of the percentage of body weight suspended. Therefore, a patient who is unweighted to 80 percent body weight is only bearing 20 percent of his weight on his or her feet; the rest of the weight is supported by the harness.
Harness systems for BWSGT are made in many different configurations, and harnesses may be ‘one size fits all’ or different sizes to accommodate individual patients. They typically allow freedom of hip movement, but some are better than others. Harness systems may or may not be on wheels or casters, the advantage of which is to allow gait training over solid ground instead of over a treadmill. However, the addition of wheels/casters does sacrifice some stability.
The Suspension System
The BWSGT suspension system is typically attached to the harness by two points or four, with suspension provided by air compression, springs, or a mechanical lift. The two-point system will often be connected to a spreader bar that is held up by a single cable. This allows movement of the patient in the transverse plane (rotation), though sometimes this may not be beneficial to the patient.
Each method affects how the patient hangs and trains in the harness, but the common theme of all systems is the act of offsetting weight from the lower limbs. The use of a treadmill allows the therapist(s) to more easily assist movement of the lower limbs, and varying levels of assistance are needed for different patients. Oftentimes only one therapist is needed to aid leg movement, though sometimes several are needed to help with different body parts during gait training. A common team approach is to have two therapists move the legs and another stand up behind the patient to stabilize the pelvis.
Advantages of BWSGT vs. Traditional Gait Training
While it may
sound like a quite an investment in labor and expense simply for another way to gait train patients, there are some key advantages to using BWSGT, and the inclusion of a treadmill may significantly improve gait symmetry and velocity during training. This in turn leads to repetitive practice in a controlled environment, much more than what can be accomplished with traditional gait training methods. Advantages of using BWSGT over traditional gait training include:
- Allows patients ordinarily too unsafe to ambulate to get on their feet and walk safely.
- Frees up the therapist to allow concentration on other aspects of gait.
- Takes less exertion to walk with some weight supported, allowing patients to train longer and at faster speeds than with other forms of training.
Helpful Tips for Getting Started
- First ensure the patient is dressed appropriately. Lightweight workout attire (including sweat pants or track suits) is best, as it allows for greater freedom of movement. Avoid overly tight or loose clothing, including hospital gowns. Comfortable walking shoes are a must; slippers, house shoes, and treaded socks are not safe for gait training on a treadmill.
- When applying the harness, make sure it fits snugly. The harness will tend to ride up the patient’s torso while walking, which can compromise control and may also cause discomfort. Periodic readjustments may be necessary, and extra padding (such as towels) may be necessary in areas where straps apply pressure (groin, greater trochanters, etc.)
- Make sure the harness is on straight. You do not want the patient to hang crooked in the harness. If you notice strange unsymmetrical gait deviations while the patient is walking, first inspect the harness alignment.
- Try to keep the pelvis in a neutral position. Too much anterior tilt will require an excessive amount of hip extension to kick in the swing reflex, and there will be a tendency for the patient to drag his or her toes more. Too much posterior tilt will cause the patient to simply sit in the harness and not weight bear properly.
Note! It is typically easier to avoid problems with harness alignment if the patient puts it on while in a supine position. 
Additional Tips:
Use the built-in harness adjustments to help with gait training. For example, if the patient has difficulty stabilizing the pelvis on one side, some systems allow you to adjust the tension higher on one side of the harness, thereby hiking up the hip slightly. If the patient is having trouble standing up straight or drags his or her feet, adjusting tension in the front of the harness will correct it by placing the patient in a slight posterior pelvic tilt. On a four-point harness this is as easy as taking up the slack in the front straps. On a two-point system you will have to adjust the tension by placing the harness down in the front (in relation to the back) before tightening it.
Brief History of BWSGT
The concept of BWSGT came about as the result of research into the walking systems of animals and the role of the cerebral cortex in controlling gait. Essentially, walking involves the coordination of countless neural structures throughout the nervous system—including complex reflexes called Central Pattern Generators (or CPGs) which are regulated by higher structures in the brain stem. There is now evidence that BWSGT actually leads to brain activation and remapping (such as with post-stroke patients), and further research indicates this type of training may have a positive effect on long-term patient abilities.
For a more detailed look at the research behind Body Weight Supported Gait Training, its clinical applications, and what to consider before purchasing equipment, view our comprehensive course Body Weight Supported Gait Training.
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