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Neuro Eval II > High Intensity Gait Training > Flashcards

High Intensity Gait Training Flashcards

1
Q

3 Important principles of neuroplasticity that apply to gait training

A

Specificity, Repetition Matters, Intensity Matters

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2
Q

Specificity

A
  • Weight-bearing, stepping, efficiency and balance are retrained SIMULTANEOUSLY during locomotor training
  • Walking is a continuous task, whole practice should be provided
  • If the goal is walking, practice walking!
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3
Q

What is intensity

A
  • workload as estimated by HR or perceived exertion
  • Active ingredient to precipitate change in walking function
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4
Q

What hormone is important for intensity

A

brain derived neurotrophic factor

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5
Q

flowchart of intensity

A

higher intensity training –> improved cardiovascular and neurologic function –> improved walking outcomes

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6
Q

High intensity gait training with Parkinson’s disease

A
  • Moderate to high intensity aerobic exercises in Parkinson disease reduces motor
    disease severity in early-stage PD
  • Moderate to high intensity aerobic exercises in Parkinson disease improve functional outcomes and quality of life in individuals with mild to moderate PD
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7
Q

High intensity gait training with multiple sclerosis

A

 High intensity interval training safe and effective in improving fitness in lower levels of
disability
 Little evidence on effects on biomarkers, need to ensure incorporating adequate rest and
avoid overheating

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8
Q

Monitoring intensity during high intensity gait training

A
  • determine Max HR (208 - 0.7age)
  • Target: 70-85% of HRmax
  • Equivalent to 15-17 on borg
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9
Q

Safety considerations

A
  • Determine if patients are medically appropriate for high intensity training
  • Monitor patient response
  • Ongoing communication with physician/medical team
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10
Q

Leap frog hypothesis

A

earlier and more aggressive therapies associated with better outcomes

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11
Q

reverse transfer

A

complex task practice translates to improvements in lower-level tasks without same amount of practice

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12
Q

Other considerations

A
  • cognition/language
  • other medical issues
  • Anticipated discharge plan –> focus on what they need to be as independent as possible
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13
Q

goals of gait training

A

 Improve gait independence
 Improve gait capacity (cardiovascular endurance)
 Improve gait speed
 Improve safety with gait (balance)

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14
Q

Variability

A
  • need kinematic, task, and environment variability
  • kinematic: body’s exploration of a movement in space (letting them start to fall but catch)
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15
Q

How many consecutive errors should you allow for?

A
  • no more than 3-5
     Error is critical for motor learning
     Too much error can result in less practice/repetition & patient disengagement
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16
Q

is the ultimate goal learning or performance?

A

learning
- performance may go down when you increase the challenge but it will promote more learning

17
Q

successful task completion

A

stepping in an intended direction with a positive step length while maintaining upright

18
Q

biomechanical components of gait

A

 Propulsion – ability to move COM in specific direction
 Limb advancement – foot clearance & positive step length
 Postural stability – maintaining upright
 Stance control – absence of limb/trunk collapse

19
Q

Common movement problems in stance control

A
  • knee buckling
  • severe knee hyperextension thrust
  • sagittal plane hip collapse
  • uncontrolled ankle equinovarus
20
Q

is stance time asymmetry a primary focus?

A

no

21
Q

common movement problems in limb advancement

A
  • inability/difficult to initiate swing
  • insufficient toe/foot clearance
  • negative step length
22
Q

is the limb advancement strategy (steppage, circumduction, etc) the patient chooses a primary focus?

A

no

23
Q

common movement problems in propulsion

A
  • slow walking speed
  • negative step length
24
Q

what is the most efficient way to elevate HR into target zone?

A

challenging propulsion

25
Q

ways to challenge propulsion

A
  • increase treadmill speed
  • overground timed challenges
  • inclines
    -banded posterior-directed resistance at pelvis
  • pushing or pulling heavy loads
26
Q

common movement problems for postural stability

A

inability to remain upright without UE use or other physical assistance

27
Q

focusing on balance may cause what to occur?

A
  • decrease in HR intensity
  • may benefit from alternating between propulsion demanding tasks and balance challenges within a session
28
Q

is treadmill or overground training better?

A
  • one is not necessarily better than the other
  • overground is more meaningful day to day
29
Q

Robotic exoskeleton

A
  • tool not an intervention
  • evidence is inconclusive
  • does show the critical active ingredients of our gait interventions include specificity, repetition, intensity, motor learning (variability and errors)
30
Q

Does evidence support practice of optimal kinematics during gait?

A
  • nope
  • emphasize kinematics only related to successful task completion (limb advancement, prevention of trunk/limb collapse, sagittal and frontal plane stability)
31
Q

Clinicians SHOULD perform:

A
  • walking training at moderate to high aerobic intensities
  • walking training with virtual reality
32
Q

clinicians MAY consider:

A
  • strength training at > 70% 1 RM
  • circuit training, cycling or recumbent stepping at 75-85% HR
  • balance training with virtual reality
33
Q

Clinicians SHOULD NOT perform:

A
  • static or dynamic balance activities including pre-gait
  • BWSTT with emphasis on kinematics
  • robot assisted gait training
34
Q

evidence does NOT support what?

A
  • body weight supported treadmill training in chronic, ambulatory post-stroke population
  • applicable to subacute neurologic populations
  • may not apply to non ambulatory individuals or those who require BWS or assistance to ambulate
35
Q

Check out the example strategies to assist with subcomponents of gait

A

Neuro Eval II (16 decks)

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