**4. Body weight–supported treadmill training approaches after spinal cord injury**

The most outstanding strategy for regaining the walking ability in SCI subjects is body weight–supported treadmill training (BWSTT) [16, 26, 28]. Traditionally, BWSTT device supported some of the SCI patient's body weight by using a harness, as therapists manually assist their legs via the stepping movement on a treadmill. Although, it has been shown that such interventions could enhance and promote locomotor activity in SCI subjects, according to the previous researches, traditional gait therapy had many disadvantages such as excessive labor load on therapists, confined training duration, and gait pattern without any feedback for patients (**Figure 4**) [17]. Therefore, body weight–supported treadmill training using lower extremity robotic exoskeleton (e.g. Lokomat) was designed and developed and initially implemented for SCI rehabilitation. The BWSTT with robotics exoskeleton has originated from the central pattern generator (CPG) and is a secure and functional intervention that allows gait training by covering the limitations of conventional gait therapy [16, 29].

exoskeleton device in conjunction with the BWSTT, in gait rehabilitation procedure, could potentially accelerate recovery of walking ability in individual following SCI through enhancing the duration of training and reducing the labor load on physical therapists [17, 28, 29].

Role of Gait Training in Recovery of Standing and Walking in Subjects with Spinal Cord Injury

http://dx.doi.org/10.5772/intechopen.71312

111

There are different types of orthoses and assistive devices for standing and walking in complete and incomplete spinal cord injury subjects [30]. This type of intervention ranged from solid ankle foot orthosis to reciprocating gait orthoses and powered gait orthoses, which

**5. Orthotic gait training**

**Figure 5.** Lokomat components.

**Figure 4.** Traditional BWSTT (A) V.S. BWSTT plus robotic exoskeleton (B).

One of the famous robotics exoskeleton use in conjunction with the BWSTT is the Lokomat (Hocoma AG, Volketswil, Switzerland), which is a bilateral robotic orthosis, worn by patients, and attaches to a treadmill frame to provide powered assistance at the hip and knee in the sagittal plane, while a therapist can check the system and regulate assistance as necessary (**Figure 5**) [17, 28].

The Lokomat has been demonstrated to be effective in producing more normal walking patterns and promoting walking ability in subjects with incomplete SCI. Generally, applying the robotic Role of Gait Training in Recovery of Standing and Walking in Subjects with Spinal Cord Injury http://dx.doi.org/10.5772/intechopen.71312 111

**Figure 4.** Traditional BWSTT (A) V.S. BWSTT plus robotic exoskeleton (B).

**Figure 5.** Lokomat components.

passive stepping by Erigo achieves this function by inducing venous return, passive stepping was less effective than FES in this study [23]. Finally, many studies are needed to extend these

The most outstanding strategy for regaining the walking ability in SCI subjects is body weight–supported treadmill training (BWSTT) [16, 26, 28]. Traditionally, BWSTT device supported some of the SCI patient's body weight by using a harness, as therapists manually assist their legs via the stepping movement on a treadmill. Although, it has been shown that such interventions could enhance and promote locomotor activity in SCI subjects, according to the previous researches, traditional gait therapy had many disadvantages such as excessive labor load on therapists, confined training duration, and gait pattern without any feedback for patients (**Figure 4**) [17]. Therefore, body weight–supported treadmill training using lower extremity robotic exoskeleton (e.g. Lokomat) was designed and developed and initially implemented for SCI rehabilitation. The BWSTT with robotics exoskeleton has originated from the central pattern generator (CPG) and is a secure and functional intervention that allows gait training by covering the limitations of conventional gait therapy [16, 29].

One of the famous robotics exoskeleton use in conjunction with the BWSTT is the Lokomat (Hocoma AG, Volketswil, Switzerland), which is a bilateral robotic orthosis, worn by patients, and attaches to a treadmill frame to provide powered assistance at the hip and knee in the sagittal plane, while a therapist can check the system and regulate assistance

The Lokomat has been demonstrated to be effective in producing more normal walking patterns and promoting walking ability in subjects with incomplete SCI. Generally, applying the robotic

**4. Body weight–supported treadmill training approaches after spinal** 

findings to the community of people with SCI with different levels of injury.

**Figure 3.** Functional electrical stimulation synchronized with leg cycling in "Erigo".

**cord injury**

110 Essentials of Spinal Cord Injury Medicine

as necessary (**Figure 5**) [17, 28].

exoskeleton device in conjunction with the BWSTT, in gait rehabilitation procedure, could potentially accelerate recovery of walking ability in individual following SCI through enhancing the duration of training and reducing the labor load on physical therapists [17, 28, 29].
