Supported Gait Training

Question 1

Goal of Supported Gait Training

Answer 1

Improved ambulation using underlying principles:
* Safety
* “Train like you walk”
* Neuroplasticity
* ‘Sensory rich’ environment

Question 2

Overground Systems

Answer 2

LIKO system (green harness)
LiteGait system (pediatric example)
Guldman system (Black Sling, Adult)

Question 3

General principles of supported gait training

Answer 3

• Weight primarily on LEs
  – Can use devices or rails as needed
• Assist only as needed for balance, limb advancement, limb stability
• Consider facilitation methods and spotting
  – Will likely need more than 1 person assist

Question 4

Manual Cues during Supported Gait Training

Answer 4

Pelvis
* assisted weight shifting
* verbal and tactile cuing for reciprocal gait pattern
* facilitation of glutes and hip flexors
* position of pelvis in neutral (e.g. decreased posterior tilt) for improved gait kinematics

Knees
* cuing directed to medial HS tendon and patellar tendons

Ankles
* cuing directed to Anterior tibialis tendon and Achilles tendons

Question 5

Liko Golvo 9000 Mobile Lift

Answer 5

SUPPORT only (to prevent falls)

Question 6

Biodex (Overland or Treadmill)

Answer 6

• Used for Body weight offloading or support

Question 7

Sample Protocol for BWS Gait Training

Answer 7

• Select over ground or treadmill environment
• Correct selection and fit of harness
• Informed consent provided
• Vitals and patient response monitored throughout experience
• Off-load least necessary percentage of weight
  – 10-40% recommended during the initial assessment phase
• Limb motion for gait – guide/facilitate as needed
• Time frame: based on individual factors and monitoring indicators
  – Typical protocol for activity-based therapy: 20-30 min on treadmill (can be split up into3-10minuteincrements) followed by 10-20 min overland training
• Gradually decrease body weight support (10% at a time) and increase speed (0.1 mph up to 3mph)
  – Speed for treadmill: goal is to gradually increase until able to practice at 2.5mph to representnormal gait speed of healthy individual
• On completion, perform visual/verbal check with patient; repeat verbal check about this session atthe next session

Question 8

Benefits of Supported and BWS Gait Training

Answer 8

• Safer
• Over treadmill or over-grounf
• With or without an assistive device
• More repetitions
• Ability to control own weight
• WB can be adjusted and documented.

Question 9

Alter-G Antigravity Treadmill

Answer 9

• Integrates patented NASA Differential Air Pressure technology, using a pressurized air chamber to uniformly reduce gravitational load and body weight in % increments
• Cost = $35,000 to $75,000