gait training

Question 1

what are the three most well- investigated interventions for gait?

Answer 1

• overground walking
• speed- dependent treadmill with/ without bodyweight
• robot- assisted gait training

Question 2

what is overground walking?

Answer 2

• observation and manipulation of the patients’ gait over a regular floor surface

Question 3

what is overground walking usually accompanied by?

Answer 3

• accompanied by practice walking overground and exercises specifically designed to improve gait

Question 4

what settings can overground walking be performed in? and why?

Answer 4

• performed in all settings as it doesn’t require technological aids

Question 5

what are the two benefits of overground walking?

Answer 5

+ walking speed
+ walking distance

Question 6

when is overground walking recommended?

Answer 6

• recommended intervention in chronic stroke patients with walking deficits or when patient is unable to walk independently

Question 7

how long should you do overground walking for?

Answer 7

• 15 to 60 minutes

Question 8

how frequent should you complete overground walking?

Answer 8

• 1 to 5 times a week
• 2 to 6 month programme

Question 9

what is speed dependent treadmill training?

Answer 9

• patients walk on a treadmill and can optionally support with one/ both upper limbs on a bar

Question 10

where does the therapist stand during speed dependent treadmill training?

Answer 10

• therapist stood beside or behind the patient

Question 11

what does the therapist monitor? what else does the therapist do?

Answer 11

• monitors balance
• instructs the patient

Question 12

what is gradually increased in speed dependent treadmill training? (3)

Answer 12

• walking speed
• walking duration
• inclination

Question 13

who should use speed dependent treadmill training?

Answer 13

• stroke patients who can walk with or without a walking aid with/ without supervision

Question 14

how long should speed dependent treadmill training sessions be?

Answer 14

• 8 to 60 minutes

Question 15

how frequently should you complete speed dependent treadmill training?

Answer 15

• 3 to 5 times week
• 2 weeks to 6 month programmes

Question 16

what are the advantages of speed dependent treadmill training? (3)

Answer 16

+ speed can be controlled
+ observation of gait is facilitated
+ therapist can more easily give manual support

Question 17

what are the two disadvantages of speed dependent treadmill training?

Answer 17

• induces a different optical flow compared with regular overground walking
• walking speed and stride lengths are shorter compared with overground walking with the cadence being higher

Question 18

what is body weight supported treadmill training?

Answer 18

• patient walks on a treadmill while the body weight is partially supported by a parachute harness

Question 19

who does BWSTT enable?

Answer 19

• enables patients who are unable to support their body weight to walk and put weight on their affected lower limb

Question 20

how many therapists are required in body weight supported treadmill training? why?

Answer 20

• requires two therapists
• one for guiding the movements of the paretic leg
• the other for the instruction and monitoring of balance

Question 21

what is the initial maximum level of support?

Answer 21

• 30 to 40%

Question 22

what happens to the level of support as time goes on?

Answer 22

• gets gradually reduced

Question 23

how long should body weight supported treadmill training be?

Answer 23

• 15 to 90 minute sessions

Question 24

what frequency should BWSTT be completed?

Answer 24

• 3 to 6 times a week
• for 2 to 6 weeks

Question 25

what is robot- assisted gait training?

Answer 25

- form of walking exercise in which the walking cycle is guided by electromechanically controlled footplates and/ or orthosis (Exoskeleton) which control the legs in a programmed walking cycle

Question 26

is the body weight supported in RAGT? what does this enable

Answer 26

- partially supported by a harness - enables high- intensity training

Question 27

how many therapists are required for RAGT?

Answer 27

- one is required as the robot moves the legs of the patient

Question 28

what are the six benefits of robot-assisted gait training?

Answer 28

+ walking speed + walking distance + heart rate + balance + walking ability + ADLs

Question 29

who is the robot assisted gait training recommended for?

Answer 29

- recommended for those with a FAC score <3 out of 5

Question 30

how long should robot-assisted gait training be completed?

Answer 30

- 15 to 60 minute sessions

Question 31

what frequency should RAGT be completed at?

Answer 31

- 3 to 7 times a week - 2 to 10 weeks

Question 32

what are the limitations of robot assisted gait training?

Answer 32

- expensive machine so limited accessibility

Question 33

what is circuit class training?

Answer 33

- 2 or more participants at the same moment using workstations that are arranged in a circuit

Question 34

what are the exercises described as?

Answer 34

- individually tailored and progressive i.e., in terms of reps and complexity

Question 35

how long do patients spend at each station?

Answer 35

- usually 5 minutes at each working station

Question 36

how many stations are usually used in total?

Answer 36

- 6 to 10 stations in total

Question 37

what is the therapist: patient ratio in circuit class training?

Answer 37

- 1:3

Question 38

how many participants are in circuit class training?

Answer 38

- 12 participants

Question 39

what are the 5 benefits of circuit class training?

Answer 39

+ walking speed + walking distance + balance + walking ability + physical activity

Question 40

who is circuit training recommended for?

Answer 40

- recommended for patients who can at least walk 10m with/ without supervision

Question 41

how long are circuit class training sessions?

Answer 41

- 30 to 75 minutes

Question 42

what is the frequency of circuit class training?

Answer 42

- 3 to 5 times a week - 4 to 19 weeks

Question 43

what are the two advantages of circuit training?

Answer 43

+ increase in therapy time without increasing demand on therapists + peer contact

Question 44

what are the most effective forms of electrostimulation of the paretic lower limb? (2)

Answer 44

- neuromuscular electrostimulation - electromyography- triggered neuromuscular electrostimulation

Question 45

what are the two movements that electrostimulation can be applied to?

Answer 45

- functional i.e., FES - non-functional e.g., eliciting DF while sitting

Question 46

what are the three benefits of NMS?

Answer 46

+ function + muscle strength + resistance to passive movements

Question 47

who is NMS recommended for?

Answer 47

- recommended for individuals who are able to stand or walk and have some volitional movements

Question 48

what are the five neurological impairment focuses?

Answer 48

- improve ROMA - improve strength - enhance balance and coordination - increase sensory awareness - functional training

Question 49

what is task- oriented training?

Answer 49

- large protocol that trains a participant to achieve a certain task

Question 50

what is an example of task oriented training?

Answer 50

- walking > elements of the gait cycle

Question 51

what should gait rehabilitation adopt? what should this consider?

Answer 51

- should adopt a top-down approach - that considers the role of the cerebral gait pattern changes

Question 52

what is it important to recognise in humans? what are they shaped by?

Answer 52

- unique walking patterns - shaped by neural info processed in the cerebral cortex and spinal cord