Treatment of Walking Deficits in Neurologic Populations

CPG recommendation to improve walking function (10MWT, 6MWT)

moderate to high intensity walking interventions, walking with virtual reality (can do strength and balance training)

why is BWSTT and robot assisted gait training no recommended to improve walking function

gives pt too much assistance and is not challenging enough

why does energy efficiency improve when people with neurological conditions walk faster

their self-selected speed is not energy efficient

components to consider when dosing exercise

repetition, intensity, specificity, duration, frequency

how to modify the intensity of a walking intervention

modify walking speed, HRR, RPE

groups of the prowalks study

FAST (capacity), SAM (performance), FAST+SAM

overground walking task of the prowalks study

walking activities that participants reported having trouble with during daily activities

results of walking capacity in prowalks study

both groups improved in 6MWT and 10MWT but the FAST group did better

HIT training results

patients were able to train at a higher speed and improved more in the 6MWT than moderate intensity aerobic training

takeaways from the HIT-STROKE study

intensity is a crucial parameter in walking interventions in chronic stroke, can see gains in walking capacity by 4 weeks with HIIT

preferred intensity parameter for training

speed is preferred over heart rate to improve walking capacity

intensity vs variability in training

high intensity is more important than high variability

considerations when practicing with variability

safety, task accomplishment, error size and number, sufficient repetition

measures of walking performance in prowalks study

steps per day, total walking time, bouts per day, average steps per bout

difference between lower level community ambulators and healthy ambulators

healthy population has more steps and bouts per day but not average steps per bout

physical capacity role in walking performance

accounts for 35-40%

important factors of walking performance

physical capacity, self-efficacy, cognition (MoCA), area deprivation index (ADI), walk score

step activity monitoring program

PTs use motivational interviewing to help pts meet step/day goal

principles to enhance motivation from motivational interviewing

express empathy, development of discrepancy between current feelings and the goal, roll with resistance then steer the conversation a different way, support self-efficacy