Technology review: EzyGain EMA

The team at PhysioFunction share their insight into the EzyGain EMA, a gait rehabilitation device which is adding further to the prominence of rehab tech in neuro-rehab and neurophysiotherapy

The EzyGain EMA has recently been introduced to the UK by Made For Movement Ltd. and PhysioFunction have been able to trial the application of the EzyGain EMA on their neurological client group. 

What is the EzyGain Ema?

The EzyGain EMA is a compact and relatively portable gait rehabilitation device complete with treadmill, force plate and falls-safe harness. It also boasts to be the first rehabilitation treadmill with 360° immersive gait training, although this feature has not yet reached the UK. With a total capacity of up to 130kg, individuals with mobility dysfunction can be supported into a full standing position with the aid of a pelvic harness if required, or alternatively walk up the ramp with any necessary walking aid before fitting the harness to ensure that activity is completely in a fall-safe environment.

The EMA offers both static and dynamic weight bearing rehabilitation, with various balance assessments and games to test weight transfer, single step and multidirectional stepping, and gait analysis software to evaluate gait symmetry, stride length and gait phase durations. Walking in virtual environments is also provided via point of view videos through popular international cities or drone footage of popular international landscapes. Furthermore, combining physical and cognitive rehabilitation is also applied with various games requiring cognitive challenges with movement to select appropriate responses.

What does the evidence say?

Bodyweight supported treadmill training is not a new concept and has been adopted widely in the field of neurological rehabilitation. Research has explored the effectiveness of bodyweight supported treadmill training in patients with Parkinson’s disease (Bishnoi et al., 2022, Lorenzo-García et al. 2021, Robinson et al., 2019), Stroke (Bishnoi et al., 2022, Nascimento et al., 2021, Gelaw et al., 2019), Multiple Sclerosis (Robinson et al., 2019), Cerebral Palsy (Han and Yun, 2020) and Spinal Cord Injury (Huang et al., 2022, Alajam et al., 2019), with findings generally supportive of treadmill training but often no more effective than conventional overground gait training and inferior to robotic assisted gait trainers, either exoskeleton or end-effector based. Studies have also been broadly of low methodological quality with little representative information of the overall populations and little long term follow up to demonstrate the benefit to overground mobility.

The use of force plates with virtual reality and game-based rehabilitation is also a well-established therapy. In 2014, Loréns et al. investigated whether customised games on a Wii balance board aided the balance rehabilitation of patients with ABI and found that significant improvements compared to standard rehabilitation that persisted at one month follow up. In a systematic review and meta-analysis, Wang et al. (2019) reported that significant improvements were reported in balance measures of Parkinson’s patients who engaged in virtual reality training compared to standard therapy, although no clear effect was evident in gait measures.

To date the EMA has not been specifically considered within the research but may offer something new. Combining bodyweight supported treadmill training, with a force plate and virtual reality combines multiple therapeutic tools into one device, with the added component of cognitive rehabilitation.

Observations from PhysioFunction’s cohort

PhysioFunction have explored the use of the EMA with a wide range of patients with neurological and orthopaedic conditions including Stroke, ABI, SCI, MS, CP, Parkinson’s disease and total hip replacement. In addition to a wide range of diagnoses, the ambulatory function of the cohort has also varied widely from 0-5 on the functional ambulation category (FAC).

In all patients the harness system has functioned effectively, offering reasonable comfort even to those requiring significant bodyweight support but for optimal support and comfort the harnesses do fit 1-2 sizes smaller. When required the support into standing has been safe and effective, requiring minimal external support. As only a pelvic harness is used the individuals require good control of their head and trunk, although an additional chest support can be fitted if required.

The software interface is extremely intuitive requiring little time to fully familiarise with the system. Calibration of the system works effectively but it was observed that any movement from the calibrated centre (i.e. moving the foot if the patient felt unbalanced), resulted in failing to effectively complete tasks without returning the foot to the resting position, which can prove challenging for those with significant proprioceptive deficits.

Our clients have enjoyed the variety and challenge of the games for balance and mobility, and the EMA offers something new in that users are required to move across the belt of the treadmill to complete the game, adding ‘real-world’ challenges to gait rehabilitation with the need to modulate the stride length, width and cadence to succeed. 

There may be a slight ceiling effect with the device only reaching 1.5kph in speed but coupled with a maximum difficulty level in the walking game, it was more than challenging enough to offer effective gait rehabilitation and re-education following neurological injury.

We found EMA to be a safe, well-tolerated and versatile piece of rehabilitation technology. Most suited to patients between FAC level 2 and 4, we are excited to see the clinical effects of longer-term use of the EMA for balance and gait rehabilitation.

References

Alajam, R., Alqahtani, A. S., & Liu, W. (2019). Effect of body weight–supported treadmill training on cardiovascular and pulmonary function in people with spinal cord injury: a systematic review. Topics in spinal cord injury rehabilitation, 25(4), 355-369.

Bishnoi, A., Lee, R., Hu, Y., Mahoney, J. R., & Hernandez, M. E. (2022). Effect of treadmill training interventions on spatiotemporal gait parameters in older adults with neurological disorders: Systematic review and meta-analysis of randomized controlled trials. International journal of environmental research and public health, 19(5), 2824.

Gelaw, A. Y., Janakiraman, B., Teshome, A., & Ravichandran, H. (2019). Effectiveness of treadmill assisted gait training in stroke survivors: A systematic review and meta-analysis. Global Epidemiology, 1, 100012.

Han, Y. G., & Yun, C. K. (2020). Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis. Journal of exercise rehabilitation, 16(1), 10.

Huang, L., liang Huang, H., wen Dang, X., & jie Wang, Y. (2023). Effect of body weight support training on lower extremity motor function in patients with spinal cord injury: a systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, 10-1097.

Lloréns, R., Albiol, S., Gil-Gómez, J. A., Alcañiz, M., Colomer, C., & Noé, E. (2014). Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in an acquired brain injury population. International Journal on Disability and Human Development, 13(3), 327-332.

Lorenzo-García, P., Cavero-Redondo, I., Torres-Costoso, A. I., Guzmán-Pavón, M. J., de Arenas-Arroyo, S. N., & Álvarez-Bueno, C. (2021). Body weight support gait training for patients with Parkinson disease: a systematic review and meta-analyses. Archives of physical medicine and rehabilitation, 102(10), 2012-2021.

Nascimento, L. R., Boening, A., Galli, A., Polese, J. C., & Ada, L. (2021). Treadmill walking improves walking speed and distance in ambulatory people after stroke and is not inferior to overground walking: a systematic review. Journal of Physiotherapy, 67(2), 95-104.

Robinson, A. G., Dennett, A. M., & Snowdon, D. A. (2019). Treadmill training may be an effective form of task-specific training for improving mobility in people with Parkinson’s disease and multiple sclerosis: a systematic review and meta-analysis. Physiotherapy, 105(2), 174-186.

Wang, B., Shen, M., Wang, Y. X., He, Z. W., Chi, S. Q., & Yang, Z. H. (2019). Effect of virtual reality on balance and gait ability in patients with Parkinson’s disease: a systematic review and meta-analysis. Clinical rehabilitation, 33(7), 1130-1138.