High Intensity Gait Training Flashcards
What Is High Intensity Gait Training?
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.
Why is High Intensity Gait Training Important?
Evidence shows that HIGT is superior to conventional treatment methods at improving patient outcomes including gait speed, gait endurance, balance, and transfers.
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?
Walking training at moderate to high aerobic intensities.
Walking training with virtual reality
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?
Strength training at >=70% 1 rep max
circuit training, cycling, or recumbent stepping at 75-85% HR max
Balance training with virtual reality
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?
Statice or dynamic standing balance activities including pre-gait
BWSTT with emphasis on kinematics
Robot-assisted gait training
What is involved in High Intensity Gait Training?
High Intensity Gait Training (HIGT) involves large amounts of structured and graded stepping practice delivered at moderate to high cardiovascular intensities.
What are the optimal heart rate or BORG RPE for HIGT?
70-85% HR max
RPE 14-18
What four aspects of training promote neuroplasticity?
Specificity, intensity, variability and error, and repetition
What is neuroplasticity?
Your brains ability to change and rewire across time.
Do you need to focus on normal kinematics in order to improve gait quality?
No - HIGT does not focus on normal kinematics
What 3 things should an exercise in a HIGT program accomplish/be?
specific to gait
challenge aerobic intensity
high repetitions
What 3 training principles do exercises meant for promoting HIGT and Neuroplasticity share?
Specificity, intensity, and repetitions
What is Biomechanical Subcomponents of Gait in HIGT?
The Biomechanical Subcomponents of Gait are a framework that provides a decision-making guide for you to implement HIGT into your clinical practice.
What do the Biomechanical Subcomponents of Gait in HIGT help you decide?
These subcomponents help you to know whether to assist or challenge the patient to drive the desired gait-related changes.
What are the 4 Biomechanical Subcomponents of Gait in HIGT?
Propulsion
Stance Control
Postural Stability
Limb Swing
Propulsion
Ability to move center mass in a specific direction (Forward, backward, etc.) during stance, separate from limb advancement.
Limb Swing
Adequate foot clearance and positive step length bilaterally
Stance Control
Absence of vertical limb or trunk collapse during stance
Postural Stability
Maintaining upright in sagittal and frontal planes, keeping center mass within base of support.
How does progression look in HIGT?
Guidance - Assist as needed - unassisted - error augmentation
How many errors should be allowed in HIGT before adjustments to the program or assistance needs to be provided and why?
no more than 3-5 errors at a time should be allowed
errors are important but having too many just waists time
Who is Appropriate for HIGT?
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.
What are the relative contraindications for HIGT?
feeling unwell (ie dyspnea, lightheadedness, fatigue)
unstable vitals (HR, BP, sp02)
Blood glucose - hypoglycemic event within 24 hours
clinical judgement
What are the absolute contraindications for HIGT?
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
Safety Considerations & Potential Barriers
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.
Which of the Biomechanical Subcomponents of Gait in HIGT have the highest metabolic cost?
propulsion
Which of the Biomechanical Subcomponents of Gait in HIGT have the lowest metabolic cost?
Postural Stability
Order the Biomechanical Subcomponents of Gait in HIGT from the highest to lowest metabolic cost?
Propulsion
stance control
limb swing
postural stability
What information should be evaluated before starting HIGT?
baseline vitals
calculate target HR zones