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Chapter Outline
Gait: Cycle and Terminology
Gait Cycle
Gait Terminology
Task Analysis
Intervention Selection, Sequencing, and Progression
Role of the Pelvis
General Principles
Prerequisite Requirements
Interventions to Improve Locomotor Skills
Ascending/Descending Stairs
Strategies for Varying Locomotor Task Demands
Body Weight Support and Treadmill Training
BWS and TM Training: Management Strategies
Robotic Assisted Locomotor Training
Outcome Measures
Summary
Student Practice Activities
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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 therapy, because it enhances participation in domestic, education, work, and social life and is associated with an overall improvement in quality of life.1–3
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This chapter focuses on interventions to address locomotor dysfunction. The continuum of locomotor training strategies involves multiple environments (e.g., parallel bars, indoor, community). An overview of locomotor training venues is presented in Box 11.1. Interventions complimentary to locomotor training include cardiovascular and strength training in addition to interventions to improve transfer skills (see Chapter 8: Interventions to Improve Transfer Skills), standing control, and standing balance (see Chapter 10: Interventions to Improve Standing and Standing Balance Skills).
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BOX 11.1 Overview of Locomotor Training Venues
A. Parallel Bars
Instruction and training in:
Sit to stand and reverse
Static and dynamic standing balance
Weight shifting and weight acceptance
Stepping forward, backward, sideward, and turning
High-stepping
Use of appropriate gait pattern with and/or without assistive device while progressing forward and turning (limited space may preclude use of an assistive device in parallel bars)
B. Overground Indoors
Instruction and training in:
Appropriate gait pattern and assistive device use (if required)
Weight shifting and weight acceptance
Stepping forward, backward, sideward, and turning
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 activities)
Stair climbing
Safe falling strategies and transitioning from the floor to standing
C. Overground Community
Instruction and training in:
Walking on different terrains (even and uneven surfaces)
Curb climbing, negotiating ramps, outdoor stairs, and sloped surfaces
Walking at varying speeds
Walking within imposed timing requirements (e.g., crossing at a stoplight, on/off elevators, escalators)
Walking for progressively longer distances
Walking while scanning for objects in the environment
Dual-task activities while walking (cognitive and/or motor dual tasks)
Walking in open environment with distracters
Entering/exiting transportation vehicles
D. Body Weight Support/Treadmill
Instruction and training in:
Stepping pattern on treadmill using BWS with maximally tolerated LE load-bearing progressing to no BWS
Reciprocal stepping pattern with manual assistance at LEs and/or trunk with normal or near normal ...