862: gait training

10m walk test

Utilizing this to measure gait speed

6 min walk test

Utilizing this to measure gait endurance

Assistive devices from most to least supportive

• parallel bars

• Platform/EVA walker

• Rolling walker

• Rollator

• Hemi walker

• Large based quad cane

• Small based quad cane

• Single point cane

• Walking poles

Task specific walking: treadmill training

• utilized to improve gait speed, gait endurance, gait symmetry, and aerobic fitness

• Provides a sensorimotor environment that facilitates recruitment of SC and brain stem pathways that make up the CPGs

Task specific walking: body weight support treadmill training

• using a harness system to off load a percentage of the persons body weight

• Utilized most in people who have paralysis or paresis

• Allows gait training practice while recovering strength

• Overtime progressing towards ability to FWB

How to manipulate intensity of gait training

• speed: overground encourage to walk as fast as possible

• Incline: treadmill, ramps, stairs

• Load

• Overall training time

Other types of walking to integrate into training

• backward ambulation

• Lateral stepping

• Obstacle negotiation

• Carrying objects while ambulating

• Unexpected perturbations

Interventions for hypokinetic gait

Focus to prevent falls, improving safety, and increasing agility to combat the impairments

• slowed speed

• Decreased stride length

• Shuffling gait

• Decreased trunk movement and arm swing

• Overall flexion during ambulation

Additional interventions for hypokinetic gait

• auditory verbal cues

• Strategies to improve step height

• Advanced stepping and balancing

• Agility course

• Reciprocal arm swing

• Use of walking sticks/hiking poles

Interventions for variable foot placement and ataxic gait

• task specific training is key

• External visual cueing, especially targets

• Ataxic limbs may respond to increased proprioceptive input and light resistance

• Compensatory interventions

3 main muscle groups contribute to the power required for forward propulsion during gait

• hip extensors: early stance

• Ankle PFs (late stance)

• Hip flexors (late swing)

2 main muscle groups contribute to the power absorption during gait

Knee extensors (early stance)

Knee flexors (late swing)

Augmenting muscle force production

Combine targeted resistance training with gait and task specific training

Ex: partial wall squats, step ups and downs, STS transfers, BL to UL calf raise

Balance and dynamic postural control during overground walking

• utilization of anticipatory and reactive balance strategies to perturbations during gait

• Interventions that challenge COG while reducing BOS

• Transitions to and from SLS

• Changing the height of the COG

• Alteration of the BOS and support surface

Circuit training

Task oriented locomotor training includes creating a variety of separate task oriented stations

Motor imagery

• mental rehearsal of movement without physical movement occurring

• Activates the same cortical structures that are activated when physically performing the movement

Neuromodulation

Use of noninvasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)