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Human locomotion is a foundational component of independent function; it represents the final and highest level of motor control (skill). It involves consistent, highly coordinated and precisely timed movements that allow for economy of effort and adaptability to changes in both task demands and the environment. It is also a skill commonly affected by impairments and activity limitations resulting in participation restrictions. Recovery or improvement in ability to walk is a high priority for many people seeking physical therapy because it enhances participation in domestic, education, work, and social life and is associated with an overall improvement in quality of life.1,2,3

The continuum of locomotor training strategies involves multiple environments (e.g., parallel bars, indoor, community). An overview of locomotor training strategies is presented in Box 10.1. Interventions complimentary to locomotor training include cardiovascular and strength training and interventions to improve transfer skills (see Chapter 7: Interventions to Improve Transfer Skills) and standing control and standing balance (see Chapter 9: Interventions to Improve Standing and Standing Balance Skills).

BOX 10.1 Overview of Locomotor Training Strategies

  1. Parallel Bars

    Instruction and training in:

    • Sit-to-stand and reverse with and/or without assistive device

    • Static and dynamic standing balance with and/or without assistive device

    • Use of appropriate gait pattern with and/or without assistive device while progressing forward and turning (because of limited space, it may not be possible to use an assistive device in standard parallel bars)

    • Weight shifting and weight acceptance

    • High-stepping

    • Stepping forward, backward, sideward, and turning

  2. Overground Indoors

    Instruction and training in:

    • Appropriate gait pattern and assistive device use

    • Weight shifting and weight acceptance

    • Stepping forward, backward, and sideward

    • Crossed-stepping and braiding

    • Walking over and around objects (i.e., obstacle course)

    • Crossing thresholds and entering/exiting through doorways

    • Variations in locomotor task demands (e.g., altering speed, scanning for objects, dual-task activity)

    • Stairs

    • Falling and transitioning from the floor to standing

    • Running

  3. Overground Community

    Instruction and training in:

    • Curb climbing, negotiating ramps, stairs, and sloped surfaces

    • Walking over even and uneven terrain

    • Walking within imposed timing requirements (e.g., crossing at a stoplight, on/off elevators, escalators)

    • Walking for long distances

    • Walking at varying speeds, walk using a rhythmic timing device (e.g. metronome)

    • Walking while scanning for objects in the environment

    • Dual-task training while walking (cognitive and/or motor dual tasks)

    • Walking in open environment with distracters

    • Entering/exiting transportation vehicles

    • Running

  4. Body Weight Support/Treadmill

    Instruction and training in:

    • Stepping on treadmill using BWS with maximally tolerated lower extremity load bearing progressing to no BWS

    • Reciprocal stepping pattern with manual assistance at LEs and/or trunk with normal or near normal lower extremity and trunk/pelvis kinematics progressing to no manual assistance

    • Production of rhythmical stepping pattern with arm swing and minimal to no weightbearing through the upper extremities

    • Progress stepping speeds to normative values based on age

    • Walking forward, sideward, and backward

    • Strategies to minimize abnormal/compensatory movement patterns

    • Strategies to improve aerobic capacity

  5. Body Weight Support/Overground

    Instruction and ...

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