High Intensity Gait Training

Question 1

What Is High Intensity Gait Training?

Answer 1

High Intensity Gait Training (HIGT) is repetitive walking and stepping practice that is vigorous enough to keep the patient’s heart rate within a certain target level.

Question 2

Why is High Intensity Gait Training Important?

Answer 2

Evidence shows that HIGT is superior to conventional treatment methods at improving patient outcomes including gait speed, gait endurance, balance, and transfers.

Question 3

What do the Clinical Practice Guidelines to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury say that you should do?

Answer 3

Walking training at moderate to high aerobic intensities.
Walking training with virtual reality

Question 4

What do the Clinical Practice Guidelines to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury say that you should consider doing?

Answer 4

Strength training at >=70% 1 rep max
circuit training, cycling, or recumbent stepping at 75-85% HR max
Balance training with virtual reality

Question 5

What do the Clinical Practice Guidelines to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury say that you should NOT do?

Answer 5

Statice or dynamic standing balance activities including pre-gait
BWSTT with emphasis on kinematics
Robot-assisted gait training

Question 6

What is involved in High Intensity Gait Training?

Answer 6

High Intensity Gait Training (HIGT) involves large amounts of structured and graded stepping practice delivered at moderate to high cardiovascular intensities.

Question 7

What are the optimal heart rate or BORG RPE for HIGT?

Answer 7

70-85% HR max
RPE 14-18

Question 8

What four aspects of training promote neuroplasticity?

Answer 8

Specificity, intensity, variability and error, and repetition

Question 9

What is neuroplasticity?

Answer 9

Your brains ability to change and rewire across time.

Question 10

Do you need to focus on normal kinematics in order to improve gait quality?

Answer 10

No - HIGT does not focus on normal kinematics

Question 11

What 3 things should an exercise in a HIGT program accomplish/be?

Answer 11

specific to gait
challenge aerobic intensity
high repetitions

Question 12

What 3 training principles do exercises meant for promoting HIGT and Neuroplasticity share?

Answer 12

Specificity, intensity, and repetitions

Question 13

What is Biomechanical Subcomponents of Gait in HIGT?

Answer 13

The Biomechanical Subcomponents of Gait are a framework that provides a decision-making guide for you to implement HIGT into your clinical practice.

Question 14

What do the Biomechanical Subcomponents of Gait in HIGT help you decide?

Answer 14

These subcomponents help you to know whether to assist or challenge the patient to drive the desired gait-related changes.

Question 15

What are the 4 Biomechanical Subcomponents of Gait in HIGT?

Answer 15

Propulsion
Stance Control
Postural Stability
Limb Swing

Question 16

Propulsion

Answer 16

Ability to move center mass in a specific direction (Forward, backward, etc.) during stance, separate from limb advancement.

Question 17

Limb Swing

Answer 17

Adequate foot clearance and positive step length bilaterally

Question 18

Stance Control

Answer 18

Absence of vertical limb or trunk collapse during stance

Question 19

Postural Stability

Answer 19

Maintaining upright in sagittal and frontal planes, keeping center mass within base of support.

Question 20

How does progression look in HIGT?

Answer 20

Guidance - Assist as needed - unassisted - error augmentation

Question 21

How many errors should be allowed in HIGT before adjustments to the program or assistance needs to be provided and why?

Answer 21

no more than 3-5 errors at a time should be allowed
errors are important but having too many just waists time

Question 22

Who is Appropriate for HIGT?

Answer 22

HIGT is considered best practice! Any patient who has experienced a chronic stroke, incomplete spinal cord injury, or traumatic brain injury and has a goal to improve walking should consider participating in HIGT. Research also supports its use in subacute populations.

Question 23

What are the relative contraindications for HIGT?

Answer 23

feeling unwell (ie dyspnea, lightheadedness, fatigue)
unstable vitals (HR, BP, sp02)
Blood glucose - hypoglycemic event within 24 hours
clinical judgement

Question 24

What are the absolute contraindications for HIGT?

Answer 24

Uncontrolled vitals (HR, BP, sp02)
Medical comorbidities -Unstable angina -uncontrolled cardiac arrythmia - Recent MI (<4 weeks), acute systemic illness/fever - Aortic dissection - acute PE/DVT - Decompensated HF New LE edema) - Moderate-severe aortic stenosis - Acute endo/myo/peri-carditis - obstructive left main artery disease

Question 25

Safety Considerations & Potential Barriers

Answer 25

The potential for adverse events with High Intensity Gait Training (HIGT) has been shown to be no greater than conventional therapy. However, implementing HIGT requires you to ensure patient safety.

Question 26

Which of the Biomechanical Subcomponents of Gait in HIGT have the highest metabolic cost?

Answer 26

propulsion

Question 27

Which of the Biomechanical Subcomponents of Gait in HIGT have the lowest metabolic cost?

Answer 27

Postural Stability

Question 28

Order the Biomechanical Subcomponents of Gait in HIGT from the highest to lowest metabolic cost?

Answer 28

Propulsion
stance control
limb swing
postural stability

Question 29

What information should be evaluated before starting HIGT?

Answer 29

baseline vitals
calculate target HR zones