WHAT IS GAIT TRAINING ?
Physical therapy to regain a normal walking pattern is called gait training. This may incorporate strength training, activities and exercises to improve balance, sequencing of the limbs and trunk, and proper step length or base of support.
GAIT TRAINING AFTER STROKE OR AMPUTAION
Gait is a persons manor of walking, movement or locomotion using their limbs. Many different things can affect a person's gait such as an injury, disease, amputation and muscle weakness. Here are some examples of common gait patterns which are not normal:
Affect gait pattern: Injury, disease, amputation, muscle weakness.
Hemiplegic gait : Unilateral weakness, drags or circumducts affected side. May include foot drop and loss of normal arm swing.
Diplegic gait pattern : Spasticity of both sides, upper extremity and lower extremity. Sometimes seen with cerebral palsy, scissoring due to tight adductors.
Neuropathic gait: Steppage gait, equinus gait, foot drop can all be causd by conditions such as peroneal nerve palsy, herniated lumbar disc, Charcot- Marie tooth disease and uncontrolled diabetes.
Myopathic gait : a weak gluteus medius muscle causes a Trendelenburg pattern. Hip surgery and or muscular dystrophy may cause this abnormal way of walking.
Ataxic gait : Uncoordinated gait due to disease or injury to the cerebellum, the area of the brain that controls muscle movement. This is characterized by a clumsy, staggering wide stance pattern.
Pakinsonsonian gait: This is seen with Parkinson's Disease. A rigid, stooped pattern with the head and neck flexed forward.
GAIT TRAINING AFTER A STROKE
Stroke or CVA cerebral vascular accident affects more than 75,000 people in the United States each year. A stroke depending on the severity can greatly affect a person's gait. Decreased muscle strength, balance, and proprioception not only inhibits the ability to walk but puts the patient at risk of falling resulting in a possible hip fracture or worse.
The propulsion of the human body by walking occurs in phases as the lower limbs move. Walking consists of a repeated gait cycle. The cycle consists of two phases, stance phase and swing phase. Stance phase is 60% of the gait cycle and is divided into heelstrike ,support and toe off. Swing phase is 40% of the gait cycle and is divided into leg lift and swing phase. Various muscles and sets of muscles are involved around each joint of the lower extremity. These muscles can be affected after a stroke and must be rehabilitated during physical therapy correctly during each phase of gait to return to a normal pattern or cycle.
Muscle strength and control of volutary movement is the primary goal of physical therapy after a stroke. Speed of walking, endurance, walking on various surfaces and around objects, climbing steps and curbs all while maintaining balance are all incorporated in a gait training program. Repetitive practice of a task, in this case walking, facilitate sensory and motor systems after a stroke. Sometimes assistive devices such as an AFO (ankle foot orthosis) , canes or walkers are used to aid in the ability to walk and the patient must be able to use them correctly.
WHEN DOES PHYSICAL THERAPY BEGIN AFTER STROKE ?
Physical therapy should begin as soon as the patient is stable. Strength, coordination, balance and the ability to walk can all be affected after a stroke. Physical therapy starts in the hospital. A functional asssesment is made then any deficits are addressed in the plan of care. The severity of the stroke dictates how much therapy is needed. Some stroke survivors have very minimal declines in their ability while others can be totally disabled. After discharge from the hospital, the patient can go home and continue therapy with home health or at an out patient facility. Sometimes a more severe stroke requires admission to a rehab hospital or skilled nursing facility. The goal of therapy should be to regain as much function as possible prior the CVA.
GAIT TRAINING AFTER AMPUTATION
85,000 amputation are performed in the United States each year. Limb amputations are usually casued by trauma, poor blood flow, diabetes, infections, burns, frostbite, and chronic wounds. Losing a limb is devestating. Patients along with family have to deal with the physical and emotional aspects of adjusting to life after amputation. Learning how to walk again with a prosthesis is very difficult and can be frustrating for the patient during the rehabilitation process.
Once the patient receives their prosthesis, gait training along with continued strength and balance training are a necessary part of the rehab process to regain functional mobility. A normal gait pattern and good balance is the goal for any lower limb amputee. The level of amputation dictates the type of prosthesis i.e above knee or below knee. The higher the amputation the more challenging the rehab process will be. In combination with gait training, the patient must be able to properly don/doff or put on and take off the prosthesis. With an above knee amputation, the patient must be able to control the mechanical knee. Learning how to load the forefoot or toe to flex the knee and progress through the gait cycle during ambulation is critical. As the patients strength and standing balance improve, more advanced and challenging techniques are incorporated to enable the patient to walk across various surfaces at speeds or cadence that is appropriate for the task, i.e walking across a street, parking lot or around other people.
SUSPENDED GAIT TRAINING
Suspended gait training is when the patient is in a harness and their body weight can be reduced and the patient can't fall during gait and balance training. This type of system is a track and trolley system installed in the ceiling and walls enabling the patient to walk freely inside an outpatient or hospital setting. It can also be an A-Frame type construction with the patient walking on a treadmill. The track and trolley system allows for advanced balance and gait activities without the patient or therapist worrying about falling. It enables the patient to maintain posture,reduce load, and increase motor control. This type of gait training has shown to increase the quality of gait and improve balance faster than traditional gait training with only a gait belt.
At Excel Rehabilitation Services you are connected to a 40' track & trolley system suspended from the ceiling and connected to a frame inside of the walls. Our Suspended Gait Training System is an adjustable pulley and harnesses system that makes it an easy fit for tall and obese patients. Our system allows for two patients to gait train on same track.
Please give us a call at 225.644.0290. We will be glad to give you more information. Or you can make an appointment to come by & see our SGTS for yourself. Check out our video on Facebook. https://www.facebook.com/118275788336728/videos/678899779572662
IF YOU NEED PHYSICAL THERAPY AFTER A STROKE OR AMPUTATION CONTACT EXCEL REHABILITATION
SERVICES AT 2251 S BURNSIDE AVE
GONZALES, LA
https://www.hindawi.com/journals/jdr/2019/4512501
https://www.amputee-coalition.org/resources/importance%20of%20gait%20training/
https://www.cdc.gov/stroke/facts.htm