Treadmill training with harness support: selection of parameters for individuals with poststroke hemiparesis

Locomotor training with a treadmill and harness support is a promising, task-oriented approach to restoring gait function in individuals with poststroke hemiparesis. However, a scientific basis for the proper selection of training parameters is lacking. Considerable latitude exists in the application of locomotor training, and training protocols vary widely between experimenters and clinical settings. Recent studies indicate that the prescription of certain parameters, including body-weight support (BWS) and treadmill speed, can affect treatment outcome in hemiparetic individuals. As an initial step toward developing a basis for selection of parameters, we reviewed the literature for studies that quantified the immediate (i.e., within session) biomechanical effects of adjusting BWS, treadmill speed, support stiffness, and handrail hold during treadmill walking in hemiparetic and nondisabled subjects. We then summarized results from personal investigations of these parameters. Based on the currently available evidence, we discuss the scientific rationale for selecting certain training parameters for individuals with poststroke hemiparesis and outline future directions for research.