Interventions to Promote Recovery of Locomotor Function

Purpose of Locomotor Intervention includes MAJOR goal for all stakeholders, improvements in locomotor function which decreases burden of care & facilitates

participation in social roles & recreational activities

Increases quality of life

Improves overall health status & physical functioning

What are the major requirements of walking?

Support of body mass by the LEs

Production of locomotor rhythm

Dynamic postural control of moving body

Propulsion of body in intended direction

Adaptability of locomotor response to changing env & task demands

the general principles include no 1 intervention has been found to be superior to another, principles of what MUST be incorporated?

neuroplasticity & motor learning (maximizes effectiveness)

What are the general principles of neuroplasticity?

Maximize repetitions, High intensity

Make activity task-specific

Increase pt choice/autonomy

Challenging/engaging

Goal-directed & meaningful/salient

General Principles of Practice include what ideal type of practice? 

Variable= different variants in varying contexts

Random= different tasks in random order

Improve retention & motor learning

More closely resemble real-world task

General Principles of Feedback: Feedback is helpful for motivation! Provide pre-task for confidence. Include what type of feedback?

Knowledge of Results (KR): Summary or faded schedule. Increase use w/ successful trials & decrease use w/ unsuccessful trials

External focus of attention

Locomotor Training w/ BW Support facilitates standing & stepping w/ more symmetry. Reduces need for excessive UE support/compensatory mvmt. Facilitates

automatic walking mvmts & reciprocal stepping

PT can facilitate mvmt & provide sensory cues

Earlier initiation of gait training

Decreases fear of falling

Prevents learned non-use

Promotes dynamic balance

Facilitates hip extension

Lots of repetition, must walk over ground

do not use w/ someone who can walk

TM training can provide a sensorimotor env to facilitate recruitment of CPGs. Helps to produce rhythmic, reciprocal muscle activity needed for gait. Allows for task-specific training w/ increased intensity. TM can act as an

External pacemaker

Improves rhythm, cadence, symmetry of stride length

Provides motor skill practice + aerobic conditioning

for pts who don’t need quite as much A w/ walking

overground training looks at 4 biomechanical subcomponents of gait

propulsion

swing:

stance:

postural stability:

what adjunct intervention to promote locomotor recovery uses video or other gaming systems

Evidence for small, but sig improvements in gait speed, stride & step length

Challenging, allow for random practice, motivating, & provide external focus of attention

Virtual Reality & Exergaming

overground propulsion training examples

incline/hill, steps (reciprocal, every other), resisted walking, sled push, faster speed, timed challenges

overground swing training examples

obstacle avoidance (over/toward targets), ankle weights/bands, stairs

overground stance training examples

stepping activities w/ increase SL stance demand, stairs, uneven/compliant surface, weighted vest, decrease UE support

overground postural stability training examples

uneven/compliant surfaces, perturbations (internal/external), decreased sensory input, decreased UE support, change in direction, dual task

what adjunct intervention to promote locomotor recovery has use of functional strengthening in context of tasks that are specific to positions & modes of contraction that are limited in gait?

Endurance vs power dependent upon limitation

Force Production Interventions

what adjunct intervention to promote locomotor recovery uses LOS training → weight shifting & perturbations?

COM control while decreasing/changing BOS (heel raise, toe off, transition between limbs)

Changing BOS, support surfaces, visual input, load

Walk w/ changes in vision, stops/starts, speed changes, obstacles

Balance & Dynamic Postural Control

what adjunct intervention to promote locomotor recovery promotes variable, random practice?

Manipulate tasks through speed, added load, added cognitive challenge

circuit training

what adjunct intervention to promote locomotor recovery uses mental rehearsal w/o mvmt?

Activates similar cortical structures as actual mvmt

Visual: Visualize the activity from 3rd person

Kinesthetic: Imagine the experience from 1st person

Generally in addition to physical practice

motor imagery

what kind of motor imagery training where you visualize the activity from 3rd person?

Visual

what kind of motor imagery training where you imagine the experience from 1st person?

Kinesthetic