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Gait Training

What is Gait Training?

The pattern of how a person walks is called the gait. Many different types of walking problems occur without a person’s control. Most, but not all, are due to some physical condition.

What are the equipments used in gait training?

Some walking abnormalities have been given names:

  • Propulsive gait : a stooped, stiff posture with the head and neck bent forward
  • Scissors gait : legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
  • Spastic gait : a stiff, foot-dragging walk caused by a long muscle contraction on one side
  • High Steppage gait : foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking or hip -circumduction during walking
  • Waddling gait : a duck-like walk that may appear in childhood or later in life
  • Ataxic or broad-based gait : a walk like drunken person walking.

What are the conditions that cause gait problems?

Walking abnormalities are unusual and uncontrollable walking patterns that are usually due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear etc.

CAUSES OF SPECIFIC GAIT:

Propulsive gait:

  • Poisoning (eg.Carbon monoxide , Manganese )
  • Parkinson’s disease
  • Use of certain drugs including phenothiazines, haloperidol, thiothixene, loxapine, and metoclopramide (usually drug effects are temporary)
  •   Spastic (scissors) gait:
  • Brain abscess
  • Brain or head trauma
  • Brain tumor
  • Cerebrovascular accident (stroke)
  • Cerebral palsy
  • Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
  • Liver failure
  • Multiple sclerosis
  • Pernicious anemia
  • Spinal cord trauma
  • Spinal cord tumor
  • Syphilitic meningomyelitis
  • Syringomyelia

Steppage gait:

  • Guillain-Barre syndrome
  • Herniated lumbar disk
  • Multiple sclerosis
  • Muscle weakness of the tibia
  • Peroneal neuropathy
  • Poliomyelitis
  • Spinal cord injury

Waddling gait:

  • Congenital hip dysplasia
  • Muscular dystrophy
  • Muscle disease (myopathy)
  • Spinal muscle atrophy

Ataxic or broad-based gait:

  • Acute cerebellar ataxia
  • Alcohol intoxication
  • Brain injury
  • Damage to nerve cells in the cerebellum of the brain (cerebellar degeneration)
  • Medications (phenytoin and other seizure medications)
  • Polyneuropathy (damage to many nerves, as occurs with diabetes)
  • Stroke

Type of Intervention we use in our centre:

  • Over-ground training: Walking over ground required for any medical condition where it required regaining walking independently and safely.
  • Includes –walking with obstacles
  • Up slope and down slope
  • Stairs going up and down
  • Walking on foam surface to increase perturbation
  • Walking with stick, Elbow crutch or elbow frame, wheeled walker or normal walker
  • Walking with Artificial limb – post – amputation.

Brace-assisted walking – Brace assisted walk where it required people who find difficult to carry their body weight on to affected part of lower limb and required brace or calliper to walk. This usually requirement post –

Functional electrical stimulation (FES):

(Click here for more information)

Rhythmic auditory facilitation training:

Treadmill training : Use to help with improving endurance and cardio respiratory functions. Usually effective post cardiac surgery or medical condition where generalised weakness lead poor endurance.

Functional lower extremity training: Lower extremity training is useful with people who suffered from sensory loss, limb loss (eg. Amputation) and walking with aid and prosthesis. This particular training is aim to adapt environment by improving upper limb strength and learning new ways of walk with use of supportive aid.

Treadmill training and body-weight support (BWS) combined :

‘Enables safe and early Patient Mobilisation’

Neuroscience Physiotherapists, Kings College Hospital, London

Body weight support system enables partial weight- bearing therapy to be conducted with the reassurance of patient comfort and safety, and with convenient access to the patient for manual assistance and observation. Unlike simple patient lift devices, this specific Biodex Unweighing Systems incorporate a dynamic suspension system that accomodates the vertical displacement of the centre of gravity that occurs during normal gait. This off-loading mechanism maintains constant force by simply dial the amount to off load. When walking, an individual’s centre of gravity typically moves through a vertical range from one to four inches (2.5 to 10cm), depending on the speed. This System accommodates up to four inches of vertical displacement while maintaining a consistent level of un-weighing. Another component of normal gait is pelvic rotation. Two- point suspension systems have a tendency to restrict rotation on the horizontal plane. They respond to pelvic rotation similar to the way a p a y g round swing undulates back to neutral after being twisted. The single-point suspension of the Biodex system allows unrestricted pelvic rotation. In case, should pelvic stabilisation be desired cords are attached to the support vest and adjusted for specific degrees of stabilisation

With a Biodex Un-weighing System, the patient can change direction without repositioning the entire patient support system. Also the confidence gained by not having to hold themselves up focuses the patient on making even steps, and reduces the tendency to walk slowly. When training with a treadmill, single point suspension permits functional pelvic rotation and versatility when walking, side-stepping, retro-walking and turning.

Home Care for Gait Difficulties:

Treating the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.

Physiotherapist almost always helps with short-term or long-term gait disorders. Therapy will reduce the risk of falls and other injuries.

For an abnormal gait that occurs with conversion disorder, counselling and support from family members are strongly recommended.

For a propulsive gait:

  • Encourage the person to be as independent as possible.
  • Allow plenty of time for daily activities, especially walking. People with this problem are likely to fall because they have poor balance and are always trying to catch up.
  • Provide walking assistance for safety reasons, especially on uneven ground.

For a scissors gait:

  • People with a scissors gait often lose skin sensation. Skin care should be used to avoid skin sores.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
  • Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle over activity.

For a spastic gait:

  • Exercises are encouraged.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
  • A cane or a walker is recommended for those with poor balance.

With of advice of consulting doctors, medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity.

For a steppage gait:

  • Get enough rest. Fatigue can often cause a person to stub a toe and fall.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. Physiotherapist can supply these and provide exercise therapy, if needed.

The pattern of how a person walks is called the gait. Many different types of walking problems occur without a person’s control. Most, but not all, are due to some physical condition.

What are the equipments used in gait training?

Some walking abnormalities have been given names:

  • Propulsive gait : a stooped, stiff posture with the head and neck bent forward
  • Scissors gait : legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
  • Spastic gait : a stiff, foot-dragging walk caused by a long muscle contraction on one side
  • High Steppage gait : foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking or hip -circumduction during walking
  • Waddling gait : a duck-like walk that may appear in childhood or later in life
  • Ataxic or broad-based gait : a walk like drunken person walking.

What are the conditions that cause gait problems?

Walking abnormalities are unusual and uncontrollable walking patterns that are usually due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear etc.

CAUSES OF SPECIFIC GAIT:

Propulsive gait:

  • Poisoning (eg.Carbon monoxide , Manganese )
  • Parkinson’s disease
  • Use of certain drugs including phenothiazines, haloperidol, thiothixene, loxapine, and metoclopramide (usually drug effects are temporary)
  •   Spastic (scissors) gait:
  • Brain abscess
  • Brain or head trauma
  • Brain tumor
  • Cerebrovascular accident (stroke)
  • Cerebral palsy
  • Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
  • Liver failure
  • Multiple sclerosis
  • Pernicious anemia
  • Spinal cord trauma
  • Spinal cord tumor
  • Syphilitic meningomyelitis
  • Syringomyelia

Steppage gait:

  • Guillain-Barre syndrome
  • Herniated lumbar disk
  • Multiple sclerosis
  • Muscle weakness of the tibia
  • Peroneal neuropathy
  • Poliomyelitis
  • Spinal cord injury

Waddling gait:

  • Congenital hip dysplasia
  • Muscular dystrophy
  • Muscle disease (myopathy)
  • Spinal muscle atrophy

Ataxic or broad-based gait:

  • Acute cerebellar ataxia
  • Alcohol intoxication
  • Brain injury
  • Damage to nerve cells in the cerebellum of the brain (cerebellar degeneration)
  • Medications (phenytoin and other seizure medications)
  • Polyneuropathy (damage to many nerves, as occurs with diabetes)
  • Stroke

Type of Intervention we use in our centre:

  • Over-ground training: Walking over ground required for any medical condition where it required regaining walking independently and safely.
  • Includes –walking with obstacles
  • Up slope and down slope
  • Stairs going up and down
  • Walking on foam surface to increase perturbation
  • Walking with stick, Elbow crutch or elbow frame, wheeled walker or normal walker
  • Walking with Artificial limb – post – amputation.

Brace-assisted walking – Brace assisted walk where it required people who find difficult to carry their body weight on to affected part of lower limb and required brace or calliper to walk. This usually requirement post –

Functional electrical stimulation (FES):

(Click here for more information)

Rhythmic auditory facilitation training:

Treadmill training : Use to help with improving endurance and cardio respiratory functions. Usually effective post cardiac surgery or medical condition where generalised weakness lead poor endurance.

Functional lower extremity training: Lower extremity training is useful with people who suffered from sensory loss, limb loss (eg. Amputation) and walking with aid and prosthesis. This particular training is aim to adapt environment by improving upper limb strength and learning new ways of walk with use of supportive aid.

Treadmill training and body-weight support (BWS) combined :

‘Enables safe and early Patient Mobilisation’

Neuroscience Physiotherapists, Kings College Hospital, London

Body weight support system enables partial weight- bearing therapy to be conducted with the reassurance of patient comfort and safety, and with convenient access to the patient for manual assistance and observation. Unlike simple patient lift devices, this specific Biodex Unweighing Systems incorporate a dynamic suspension system that accomodates the vertical displacement of the centre of gravity that occurs during normal gait. This off-loading mechanism maintains constant force by simply dial the amount to off load. When walking, an individual’s centre of gravity typically moves through a vertical range from one to four inches (2.5 to 10cm), depending on the speed. This System accommodates up to four inches of vertical displacement while maintaining a consistent level of un-weighing. Another component of normal gait is pelvic rotation. Two- point suspension systems have a tendency to restrict rotation on the horizontal plane. They respond to pelvic rotation similar to the way a p a y g round swing undulates back to neutral after being twisted. The single-point suspension of the Biodex system allows unrestricted pelvic rotation. In case, should pelvic stabilisation be desired cords are attached to the support vest and adjusted for specific degrees of stabilisation

With a Biodex Un-weighing System, the patient can change direction without repositioning the entire patient support system. Also the confidence gained by not having to hold themselves up focuses the patient on making even steps, and reduces the tendency to walk slowly. When training with a treadmill, single point suspension permits functional pelvic rotation and versatility when walking, side-stepping, retro-walking and turning.

Home Care for Gait Difficulties:

Treating the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals.

Physiotherapist almost always helps with short-term or long-term gait disorders. Therapy will reduce the risk of falls and other injuries.

For an abnormal gait that occurs with conversion disorder, counselling and support from family members are strongly recommended.

For a propulsive gait:

  • Encourage the person to be as independent as possible.
  • Allow plenty of time for daily activities, especially walking. People with this problem are likely to fall because they have poor balance and are always trying to catch up.
  • Provide walking assistance for safety reasons, especially on uneven ground.

For a scissors gait:

  • People with a scissors gait often lose skin sensation. Skin care should be used to avoid skin sores.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
  • Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle over activity.

For a spastic gait:

  • Exercises are encouraged.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.
  • A cane or a walker is recommended for those with poor balance.

With of advice of consulting doctors, medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity.

For a steppage gait:

  • Get enough rest. Fatigue can often cause a person to stub a toe and fall.
  • Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. Physiotherapist can supply these and provide exercise therapy, if needed.
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