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Chapter Objectives

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Upon completion of this chapter, the learner should be able to:

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  1. Describe the biomechanical and motor control characteristics of gait.

  2. List the primary impairments that affect upright mobility in patients with neurological disorders.

  3. Select tests and measures to examine upright mobility across the International Classification of Functioning Disability and Health (ICF) domains of impairments in body structure and function, activity limitations, and participation restrictions.

  4. Discuss the clinical management of patients with disorders of upright mobility.

  5. Explain the evidence that supports the use of body weight–supported treadmill training for patients with upright mobility disorders.

  6. Design an intervention using functional mobility activities to address a specific patient’s mobility disorder.

  7. Explain how to modify upright mobility activities to vary task complexity.

  8. Describe factors that contribute to dual task control and explain how to use Gentile’s Taxonomy of Tasks to train dual task performance.

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Introduction

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Mrs. Z is an 81 year-old female who sustained an infarct to the right middle cerebral artery 3 days ago, resulting in left hemiplegia. She is in a local hospital and has been receiving physical therapy and occupational therapy daily for 30 to 45 minutes each. Her medical history includes hypertension, which has been pharmacologically managed since its onset at age 40 years. Her vision and hearing are within functional limits. Before the injury, Mrs. Z lived at home with her husband and was independent in all activities of daily living. She enjoys cooking, cleaning, and shopping. She resides in a ranch-style home; however, five steps must be climbed to enter the home. There is one bathroom with a tub-shower stall combination.

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Upright mobility includes all forms of moving the body from one place to another while in an upright position. Upright mobility tasks include walking on level surfaces, walking on a ramp, stepping over obstacles, and climbing stairs. Walking, the most common form of upright mobility, is a complex task typically affected in patients with progressive and nonprogressive nervous system disorders. Gait disturbances may signal the onset of a progressive neurological disease, such as multiple sclerosis or Parkinson disease (PD). Gait disturbances can also be a hallmark of nonprogressive neurological disorders such as stroke, traumatic brain injury, and cerebral palsy. Because the ability to walk contributes substantially to one’s quality of life and is highly valued by patients, families, and caregivers, therapists typically devote considerable treatment time to developing, improving, or preserving a patient’s upright mobility skills.

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Mobility tasks such as walking, stair climbing, and obstacle negotiation share common basic features: forward propulsion, postural control and balance, and adaptation to environmental conditions (Patla, 1997; Shumway-Cook, 2007). These basic features are essential for successful locomotion and can be viewed as goals for movement organization (Higgins, 1995). Effective achievement of these goals is determined by the individual’s unique abilities and resources, the requirements of the task, and the characteristics of the environment. When these ...

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