Connecting research to the needs of patients and clinicians

Modern principles of gait rehabilitation after CNS lesions favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk. Budget constrains and the required effort, e.g. to place the paretic limbs in SCI patients, limit the treatment intensity; accordingly gait machines have been introduced. One can distinguish between an exoskeleton and end-effector approach. Our group opted for the latter, less costs, faster donning and doffing as well as the potential risk of shear forces in case of a malignement between the external and internal joint axis were argumented. On the electromechanical Gait Trainer GT I, the feet are placed on plates, whose movement simulate stance and swing, the vertical and horizontal movements of the centre of mass are controlled, Functional Electrical Stimulation is optional. The HapticWalker is the next step, the foot plate trajectories are fully programmable, so that the patients can also practise stair climbing up and down. In SCI patients of traumatic and non-traumatic origin, case series including gait analysis and a single-centre study based on non-randomized SCI patients admitted to our unit within 2 years are presented. The results corresponded to those reported for the manually assisted gait training. Among the non-traumatic patient group, being elder and more frailer, less than 50% participated in the programme. The future must see controlled trials comparing the various solutions with respect to clinical practicability, effectiveness, and cost-efficiency. Also one should keep in mind that a machine will never substitute a therapist, it is an adjunctive tool.