Week 9 (b) Walking Training

Question 1

Australian stroke guidelines for walking training

Answer 1

People with difficulty walking should be given the opportunity to undertake

Tailored repetitive practice of walking (or components of walking) as much as possible.
Grade A

Question 2

Australian stroke guidelines. 1 or more of the following interventions can be used in addition to conventional walking training

Answer 2

Cueing of cadence - Grade B

Mechanically assisted gait - Grade B

Question 3

Training strategies for non-walkers

Answer 3

Manually assisted:
Overground
Treadmill

Mechanically assisted walking
Overground walking with harness
Treadmill and harness
Treadmill and electromechanical gait trainer

Question 4

Evidence for mechanically assisted walking compared to overground assisted walking for non-ambulatory patients

Answer 4

Mechanically assisted:
more independent walkers at 4 and 6 weeks.
At 6 months, mechanically assisted walking results in

Faster walking
Walking further

Question 5

Why does mechanically assisted walking produce more independent walking early on and better walking speed and distance

Answer 5

• Higher intensity of pracitce

- 3 trials report overground walking groups acheiving only 10-20% distance of mechanically assisted groups

Question 6

How much walkinf practice should be done?

Answer 6

Part and whole practice for people who can walk but have reduced speed and/or safety

NSF Grade A recommendation
“As much as possinle”
Essential to find training strategies that allow high intensity of practice
Semi/supervised independent practice

Question 7

Components of walking that can be targetted individually

Answer 7

Concentric hip extension at end of stance
Control of lateral pelvic shift
Stepping forward (working on back leg extending before front foot hits the floor)
Increasing stance time ( eg stepping up onto polystyrene cup)
Knee control (exercises making sure hip extends before knee fully extends to prevent hyperextension
Ankle PFs (standing on wedge)

Question 8

Advanced mobility

Answer 8

Uneven surfaces
Endurance
Skill
Obstacles
Balance
Outdoor Circuit

Question 9

How to cue cadence

Answer 9

External auditory rhythms EAR.

Strong evidence found for improving stride length and comfortable gait speed

Question 10

Measures of gait training

Answer 10

Velocity - 10 metre walk
Motor assessment scale : simple overview of person's abilities
Step length
Endurace: 6 minute walk test
Dual tasking - Dynamic gait index

Question 11

Prescription of walking aid after stroke

Answer 11

Don’t prescribe if you think they may one day walk without one.Even if they need one, don’t introduce until closer to discharge. Don’t want to limit recovery of person’s own ability.