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LEARNING OBJECTIVES
Select appropriate outcome measures to use with a client whose primary goal is to improve locomotion function.
Interpret change in walking ability using gait speed as an outcome measure.
Develop a practice schedule for locomotor interventions that enhances motor learning.
Utilize feedback during locomotor interventions to facilitate motor learning.
Explain how feedback can be used to enhance patient motivation.
Organize interventions to promote the recovery of locomotor function based on principles of neuroplasticity.
Develop a plan of care to improve loco-motor function that targets moderate- to high-intensity stepping training.
Describe how to provide variable practice when utilizing a treadmill to improve locomotor function.
Develop a task-specific strengthening and dynamic balance exercise program that incorporates exercise guidelines and principles of neuroplasticity to improve locomotor function.
Design a circuit-training locomotor intervention that incorporates motor learning and neuroplasticity principles.
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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.1–4 Initially, approximately two-thirds of people who experience a stroke cannot ambulate or require assistance to walk.5 Three months later, one-third of those with a stroke still require some level of assistance to walk. People with Parkinson disease (PD) often have impaired postural control and limited walking ability.6 Approximately 50% of people with multiple sclerosis (MS) require assistance to walk within 15 years of their diagnosis.7,8 Individuals with low back pain, lower extremity (LE) amputations, and a host of other health conditions often present with limited walking ability. Improving walking ability is an important goal because people who can walk independently are likely to have a lower burden of care, be able to participate in expected social roles and desired recreational activities, have a higher quality of life, be more physically active, and have improved health status.2,3,6,9–12
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EXAMINATION OF WALKING FUNCTION
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Physical therapists use a variety of tests and measures to assess locomotor function. Evaluation of gait and functional walking ability assists the physical therapist in selecting appropriate interventions, measuring change, and setting goals. The major requirements for successful walking include the following: (1) support of body mass by the LEs, (2) production of locomotor rhythm, (3) dynamic postural control of the moving body, (4) propulsion of the body in the intended direction, and (5) adaptability of the locomotor response to changing environmental and task demands. Physical therapists use observational gait analysis (OGA) as a preferred method to examine gait kinematics. One instrument used clinically is the Rancho Los Amigos (RLA) OGA System. The RLA OGA instrument gathers data on the cyclical movements of walking that occur from one stride cycle to the next. The gait cycle is divided into stance and swing phases. The physical therapist visually analyzes a patient's walking pattern, looking for asymmetries and deviations from normal. Based on these observations, ...