High Intensity Gait Training - Exam 3

gigi-senger

What were traditional approaches

Bobath/NDT

- focused on allowing "normal" movement

- lots of verbal and manual feedback

- intense exercise could worsen spasticity

PNF

True or False: Moderate-high intensity exercise does not worsen spasticity

True

True or False: Walking patterns are not "more normal" after NDT treatment

True

What are the 10 neuroplasticity principles

- Use it or lose it

- Use it and improve it

- Specificity

- Repetition matters

- Intensity matters

- Time matters

- salience matters

- age matters

- transference

- interferrence

True or False: we need to walk to improve walking

True

What is the Leap Frog Phenomenon

Idea of practicing more challenging tasks right away, the easier tasks may improve without directly working on them

Goals of HIGT

-Maximize stepping practice

-Stepping variability

-High aerobic intensities

How can we maximize stepping practice?

over ground

treadmill

How can we maximize stepping variability

- forward, backward, sideways, stairs, obstacles

- improve walking adaptability - change the environment, turns

What % of HRmax do we want to work in?

70-85%

How much do we subtract from HRmax if a patient is on beta-blockers

15 bpm

What are the key biomechanical subcomponents?

-stance control

- limb advancement (swing)

-propulsion

-balance

What is stance control?

avoiding vertical limb or trunk collapse along with a steady base

How do we assist stance control?

-body weight support via harness system

-manual blocking or bracing

-UE use

How do we challenge stance control?

-weight vest

-reduce UE use on handrails/AD

What is needed for limb advancement?

adequate foot clearance and positive step length (step through pattern)

How do we assist limb advancement?

-manual or elastic assistance (triple flex wrapping)

- AFO

How do we challenge limb advancement?

-ankle weights

-posterior-directed elastic resistance

-stepping over obstacles

-stairs

What is propulsion?

Ability to move body forward during stance phase (separate from limb swing)

How do we assist propulsion?

manual or elastic assistance at pelvis

How do we challenge propulsion?

-decrease UE support (on treadmill)

-increase stepping speed

-inclined surfaces/stairs

-elastic resistance at pelvis

What is balance?

maintaining upright posture in sagittal and frontal plane

How do we assist balance?

-manual assistance at pelvis/trunk

-stabilizing elastic assistance at pelvis (treadmill)

-use of handrails or AD

How do we challenge balance?

-decrease UE support

-progress to backward or sidestepping

-stepping over/around obstacles

-uneven, compliant, narrow surfaces

-dual physical tasks

What are the principles of HIGT

-specificity

-repetition

-intensity

-external focus of attention

-variable practice

-assist only as needed + error augmentation