(2) Gait Interventions HEMI POP Flashcards
What are the 4 main reasons to work on Gait?
- its the primary goal (salience)
- independent ambulation leads to lower burden of care and improved ability to participate in meaningful social roles
- transference (indirect improvement in other functional tasks)
- gait speed correlates with fear of falling, fall risk, strength, balance, community mobility, QOL
to improve walking function in abulatory chronic CVA, iSCI, TBI, Clinicians SHOULD perform…
walking training at moderate to high aerobic intensities, walking training with VR
(when gait at high int is not possible….)
to improve walking function in ambulatory chronic CVA, iSCI, TBI, clinicians MAY consider:
strength training at > 70% 1RM
Circuit training, cycling, or recumbent stepping at 75-85% HR max
Balance training w/ VR
Dont think you are improving gait with
balance interventions, BWSTT w manual assist
robotic walking
Why is VR good?
Neuroplasticity: Salience! (they can choose if they are on the beach or street…)
Autonomy (pts who have a choice do better)
External focus of control
WHEN VR ISN’T AVAILABLE apply these concepts!
are there CPG for gait in subacute stroke?
NO but current evidence strongly points to the same treatment principles as chronic stroke
(high rep, high intensity training to improve gait, leap-frog principle, no need to facilitate normal movements)
Evidence for HIGT: in GAIT
significant improvements in 6MWT and 10MWT
Evidence for HIGT: in balance and function
same or greater improvements in berg and functional measures (trandfers and 5xSTS)
Evidence for HIGT: in kinematics
sig improvements in speed, gait symmetry (stance time, step length)
general improvement in sagittal plane kinematics
compensatory patterns noted in frontal plane (increased gait speed in pts who are low level to start with)
How do you assess gait prior to intervention
follow movement task analysis framework (movement constructs, progressions, regressions)
intervene as little as possible by minimizing verbal, tactile cues and devices
KEEP THEM SAFE
assessing gait: if pt is independent ambulator…
walk down hall with usual devices and self selected speed.
add progressions as needed
assessing gait: if pt is not independent
focus on safety
good options: rail, hemi rail, parallel bars, bilateral hand held
add task progressions or regressions as indicated
4 variables HIGT
specificity repetition intensity and variability/error
specificity:
task specific
primary goal is to improve gait then prim intervention should be gait!
eliminate non gait interventions if time is limited
repetition
as many steps as possible in a session! minimize rest breaks, pedometer if possible
conventional therapy is 1000 steps/day
high rep therapy is 2000-6000 steps/day feasible in IPR
intensity
high HR! 70-80 HRR = HIT
use RPE as sub
Variability and error
allow and even encourage errors!
perfect practice DOES NOT equal perfect performance or motor learning!!!!
contributes to improvements in performance not just capacity
encourages improvement in non gait parameters – balance, transitional movement ect
what are the 4 biomechanical subcomponents of gait
propulsion, limb swing, postural stability, stance control
success and energy cost for propulsion
moving in a defined direction
42-48
success and energy cost limb swing
moving past CL limb
10-20
success and energy cost of postural stability
not falling (maintaining stability)
6
success and energy cost for stance
limb not collapsing
25-28
assist as needed and error augmentation for propulsion
AAN: manual assistance (walker, tech moving device forward), bands with ANT resistance
EA: verbal cues walk faster, increase treadmill speed, incline walking, resisted walking
assist as needed and error augmentation for limb swing
AAN: band ant assist, manual assistance
EA: weights, post band resist, vary direction, reciprocal stairs
assist as needed and error augmentation for postural stability
AAN: physical assist, UE support, BW support
EA: take away support, change BOS, change gait surface
assist as needed and error augmentation for stance
AAN: BW support, hand held assist
EA: weighted vests, recip. stairs
assist as needed and error augmentation for ST
