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30-SECONDS OF THERAPY: Gait Interventions That Actually Work

Jan 16

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Legs wearing rainbow sneakers balance on a large orange ball against a colorful gradient background. Vibrant, playful mood.

What is Gait? It's generally referred to as clinical description of the manner in which something ambulates or walks.

START

  1. Specific / Intense / Repetitive: Practice walking at 70-85% HR max (220-age) repetitively to promote the maximal improvements with all aspects of your patient's gait. 

  2.  Loss of Balance:  Encourage changing directions, having them close their eyes, and change speed to induce balance loss, stepping reactions, and self recovery.  

  3. Stance / Swing / Propulsion / Stability: Begin with UE support progress to less assistance. Add LE weights, stepping over obstacles, incline, stairs. Progress by increasing speed, add weighted vests, push sleds, and run.  Lastly improve stability with obstacle courses, changing direction, and walking on grass.  

STOP 

  1. Supported Treadmill Training: Only use Body weight support treadmills to help the patients get to standing and only for the first 6 months post injury. 

  2. Robotic-Assisted Devices:  Avoid these perfect movement simulators, allow errors to encourage motor learning and self correction. 

  3. Avoid Specifics: Don't cue patients, "Bend your knee more", rather create obstacles that force the patient to adapt. Have them step over a box on the ground to promote more knee flexion instead. 

WHY

  1. Gait Subcomponents: Begin with stance so they can take a step, then promote longer stride lengths by stepping over objects that will naturally force the patient to challenge their balance and improve their swing phase. Then progress to increase speed, add weights, change their surface, and change directions to increase the metabolic demand and force more rapid improvement. Remember when the body breaks down it repairs to prevent subsequent damage. 

  2. Intensity and Specificity: Avoid seated exercises, get the patient up, make them walk, and make it hard so they fall. Just make sure they don't hit the ground. :) Remember if they don't stumble they won't improve, motor programs change only when they are challenged. 

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