Interventions to Improve Locomotion

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Training Principles

  • Impairment based1
  • Task oriented to the specific task of walking1
  • Goal directed and meaningful to the patient1
  • Shaped and progressed to maximally challenge the patient’s capabilities1
  • Performed multiple times (high number of repetitions)1

Interventions

High Stepping

Read more about high stepping interventions

Locomotor Training Environments

Parallel bars

  • Sit-to-stand and reverse with and/or without assistive device
  • Static and dynamic standing balance with and/or without assistive device
  • Use of appropriate gait pattern with and/or without assistive device while progressing forward and turning
    • (because of limited space, it may not be possible to use an assistive device in standard parallel bars)
  • Weight shifting and weight acceptance
  • High-stepping
  • Stepping forward, backward, sideward, and turning

Overground indoors

  • Appropriate gait pattern and assistive device use
  • Weight shifting and weight acceptance
  • Stepping forward, backward, and sideward
  • 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 activity
  • Stairs
  • Falling and transitioning from the floor to standing
  • Running

Overground Community

  • Curb climbing, negotiating ramps, stairs, and sloped surfaces1
  • Walking over even and uneven terrain1
  • Walking within imposed timing requirements (e.g., crossing at a stoplight, on/off elevators, escalators)1
  • Walking for long distances1
  • Walking at varying speeds, walk using a rhythmic timing device (e.g. metronome)1
  • Walking while scanning for objects in the environment1
  • Dual-task training while walking (cognitive and/or motor dual tasks)1
  • Walking in open environment with distracters1
  • Entering/exiting transportation vehicles1
  • Running1

BW Support / Treadmill

  • Treadmills are a useful tool to progress an individual from maximally tolerated LE load bearing to no BW support1
  • Reciprocal stepping pattern with manual assistance at LEs and/or trunk with normal or near normal lower extremity and trunk/pelvis kinematics progressing to no manual assistance1
  • Production of rhythmical stepping pattern with arm swing and minimal to no weightbearing through the upper extremities1
  • Progress stepping speeds to normative values based on age1
  • Walking forward, sideward, and backward1
  • Strategies to minimize abnormal/compensatory movement patterns1
  • Strategies to improve aerobic capacity1

BW Support Overground

  • Walking overground with maximally tolerated lower extremity load bearing progressing to no BWS1
  • Use of assistive device (if indicated) for walking on level surfaces1
  • Reciprocal stepping pattern with manual assistance at pelvis with normal or near normal lower extremity and trunk/pelvis kinematics progressing to no manual assistance1
  • Production of rhythmical, coordinated stepping pattern with arm swing and minimal weightbearing through the upper extremities1
  • Strategies to minimize abnormal/compensatory movement patterns1
  • Strategies to maintain/regain balance when perturbed1

Assistive Devices

  • Function and purpose of assistive device1
  • Sit-to-stand and reverse with assistive device1
  • Static and dynamic standing balance with assistive device1
  • Gait pattern1
  • Use of assistive device and appropriate gait pattern indoor overground and overground in community1

References

1.
O’Sullivan SB, Schmitz TJ, eds. Improving Functional Outcomes in Physical Rehabilitation. 2nd ed. F.A. Davis Company; 2016.

Citation

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