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INTRODUCTION

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LEARNING OBJECTIVES

  1. Discuss the major elements of physical therapy intervention for patients with locomotor limitations.

  2. Describe the locomotor training principles that guide selection of interventions.

  3. Differentiate between advantages and limitations of using parallel bars for locomotor training.

  4. Explain the rationale for each component of indoor overground locomotor training.

  5. Identify strategies to vary locomotor task demands.

  6. Discuss the rationale for locomotor training using body weight support and a treadmill.

  7. Compare and contrast locomotor training using body weight support and a treadmill with other locomotor training strategies.

  8. Describe strategies for varying task and environmental demands during locomotor training.

  9. Describe training activities used for locomotion overground in the community.

  10. Using the case study example, apply clinical decision making skills within the context of locomotor training.

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The recovery or improvement of walking ability is a primary goal for people with many different health conditions who seek the services of a physical therapist.1,2,3 Initially, approximately two-thirds of people who experience a stroke cannot ambulate or require assistance to walk.4 Three months later, one-third of those with a stroke still require some level of assistance to walk.4 Approximately 70% of people with a spinal cord injury (SCI) cannot walk 1 year after their injury.5 People with Parkinson's disease (PD) often have impaired postural control and limited walking ability.6 Individuals with low back pain, lower extremity (LE) amputations, multiple sclerosis (MS), and a host of other health conditions all may present with impaired locomotion. The Guide to Physical Therapist Practice includes elements of gait and locomotor training (LT) as an intervention category within each of the four preferred practice patterns.7

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The recovery of walking ability is such an important goal because people who can walk independently are more likely to be able to participate in expected social roles and desired recreational activities, have a higher quality of life, and have improved health status.2,3,6,8,9

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The major requirements for successful walking include the following:

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  • Support of body mass by the LEs

  • Production of locomotor rhythm

  • Dynamic postural control of the moving body

  • Propulsion of the body in the intended direction

  • Adaptability of the locomotor response to changing environmental and task demands

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These requirements should be performed in an energy-efficient manner so as to minimize stress on the individual.

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Recent advances in basic science research using animal models of different neurological health conditions provide a strong foundation for physical therapy interventions designed to improve locomotor capability in different patient populations. Research using an SCI cat model has found that spinalized cats trained by suspension in a harness over a treadmill (TM) and provided with manual assistance to step can learn to walk/step on the TM without supraspinal input.10,11,12 Studies incorporating an animal model of stroke indicate that skilled, repetitive, task-oriented ...

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