Gait training
Normal human gait is a complex process, which happens due to co-ordinated movements of the whole of the body, requiring the whole of Central Nervous System - the brain and spinal cord, to function properly.
[2] Assistive devices and splints (orthosis) are often used in gait training, especially with those who have had surgery or an injury on their legs, but also with those who have balance or strength impairments as well.
An understanding of a normal gait cycle and how it progresses is crucial to determining how much assistance a patient needs in order to return to functional ambulation.
[1] Assistive devices (ADs) are given to patients who have difficulty maintaining a regular gait cycle or balance due to an injury to one or both of their legs.
[2] Not only does an AD provide extra support, it can also protect the injured leg and prevent it from being further aggravated due to weight bearing requirements.
[2] The type of gait that a patient is instructed in is based on their weight-bearing status, or how much of their body weight can be supported on their legs, coordination, and strength.
[2] A gait belt is also utilized by the physical therapist in order to support the patient and to prevent them from falling or placing too much weight on the injured leg.
[2] In this pattern there is only use of one crutch or cane on the side opposite to the injured leg, therefore there can not be any weight bearing restriction but is more used to provide extra balance.
[6] BWS systems can be used prior to the patient gaining adequate motor control or having sufficient strength to fully bear weight.
[8] Gait training techniques that utilize a BWS system appear to be promising in their ability to improve and possibly restore walking function, as demonstrated in individuals suffering from incomplete spinal cord injuries.
Body-weight-supported treadmill training (BWSTT) enables individuals with motor deficits that have rendered them incapable of completely supporting their own body weight to practice and experience locomotion at physiological speeds.
[9] Depending on the severity of the person's impairment, one or more physiotherapists may be present to assist in maintaining the patient’s appropriate posture and moving their legs through as kinematically physiological a gait pattern as possible.
electromechanical devices such as the Hocoma Lokomat robot-driven gait orthosis have been introduced with the intention of reducing the physical labour demands on therapists.
[9][10] This system uses a computer-controlled exoskeleton to repeatedly and consistently guide lower-limb movements, making BWSTT a more feasible option for long-term and widespread use.
The German society for Neurorehabilitation has recently recommended end-effector devices for gait rehabilitation after stroke due to current medical evidence.
[11] Treadmill training, with or without a body-weight support, is an emerging therapy and is being used with stroke patients to improve kinematic gait parameters.
Literature continues to emerge examining the influence treadmill speed may have on the improvement of gait patterns and functional independence.
[13] Improvements in gait parameters included walking speed, cadence, stride length and Functional Ambulation Category scores.
Research has shown that this form of gait training demonstrates a more normal walking pattern without the compensatory movements commonly associated with stroke.
[16] Evidence demonstrates that this method should only be applied to people who are unable to walk and it should be used in the first 3 months after the stroke, in order to maximize results.
