Weight Distribution Systems for Balance and Gait: Clinical Evidence and Testable Neural Mechanisms

This systematic review with qualitative synthesis evaluates the clinical evidence for weight distribution systems (WDS), including Balance-Based Torso Weighting (BBTW) and related limb/torso loading strategies, on balance and gait outcomes across neurological populations. The review synthesizes findings from 14 studies spanning multiple sclerosis, Parkinson's disease, spinocerebellar ataxias, and older adults with balance impairment. Beyond summarizing clinical outcomes, the review proposes testable mechanistic hypotheses (sensorimotor recalibration and circuit-level adaptations) and presents a phased translational research agenda integrating EEG, fMRI, and TMS with instrumented posturography. Due to extreme heterogeneity in populations, intervention protocols (25 g–2 kg; minutes to months), and more than 15 different outcome instruments, meta-analysis was not feasible; findings were synthesized qualitatively following SWiM guidelines. Risk of bias was assessed using ROBINS-I for non-randomized studies and PEDro for randomized trials. This registration is retrospective, completed prior to manuscript submission. The review follows PRISMA 2020 and PRISMA-S reporting guidelines.