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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


Student Practice Activities

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

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).

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 ...

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