Maybe you can get something out of this, not detailed enough to be a protocol and I see nothing that suggests any objective starting point was used. So from my perspective, not needing to be medically trained, useless.
Training Conditions Influence Walking Kinematics and Self-Selected Walking Speed in Patients with Neurological Impairments
2011, Journal of Neurotrauma
Gavin Williams, 1
Ross Clark, 2
Anthony Schache, 3
Natalie A. Fini, 4
Liz Moore, 5
Meg E. Morris, 2
and Paul R. McCrory 6
Introduction
Gait training
is a major focus of rehabilitation for many people with neurological disorders (Harris and Eng,2004), with gait speed regarded as a good indicator of functional mobility (Schmid et al., 2007). Despite the considerable costs associated with being immobile and the large number of studies investigating the effectiveness of various gait training techniques, to date no regimen has been shown to be superior(Dickstein, 2008; Moseley et al., 2005; States et al., 2009; Wessels et al.,2010).Contemporary therapies for training gait fall into three main categories: (1) facilitation or assistance provided by a therapist, (2) gait-assistive devices, such as sticks, frames, and crutches; and (3) partial body weight support (BWS) provided by a harness suspended overhead.The most common means of providing partial BWS gait training, also known as BWS treadmill training (BWSTT), uses a harness to provide support and stability while the patient practices walking on a treadmill (Hesse, 2008). Reduced ability to walk and reduced walking speed fol-lowing neurological injury may be related to restricted opportunities to practice during rehabilitation (Bernhardt et al.,2008). Consequently,there has been much focus on BWSTT in recent years, because it provides the advantage of engaging in more task specific practice (Hesse et al., 1995), a term used to describe motor training that is context specific (Teasell et al.,2008). Task specific practice is the optimal approach for training motor skills(Dobkin,2004). Although included in the American Heart Association’s Definitive Stroke Guidelines(Miller et al., 2010), the efficacy of BWSTT remains unclear.Seven systematic reviews have investigated the effectiveness of BWSTT for people with neurological conditions and found little benefit from this approach, as training gains have not generalized well to over-ground walking (Dickstein, 2008;Marshall et al., 2007; Mehrholz et al., 2007; Moseley et al.,2005; States et al., 2009; Swinnen et al., 2010; Wessels et al., 2010). The most recent systematic review included six BWSTT and electromechanically assisted gait training studies in subacute stroke(Adaetal.,2010b). They reported that BWSTT(two studies) was more effective than over ground walking in achieving independent ambulation, despite the fact that this modality has little effect on gait speed. No reasons for the failure of the enhanced training times provided by BWSTT to improve mobility outcomes have been proposed.Randomized controlled trials investigating the effectiveness of BWSTT have usually compared outcomes to conventional gait training. Although conventional therapy may incorporate a range of strengthening, balance, and stretching exercises, conventional gait training usually involves thera-pist assistance or facilitation (Hesse et al., 1994, 1998; Hornby et al., 2008; Lennon, 2001; Moseley, 2005). Therapist facilitation may vary considerably between rehabilitation centers and between therapists with different levels of experience. A perceived advantage of therapist facilitated gait training isthe ability to continually adapt the assistance provided in response to the person’s performance from stride to stride(Lennon, 2001). Whether or not therapist facilitation is a more effective strategy than other gait-training conditions remains unclear.The use of assistive gait devices, such as walking frames,crutches, and canes, is common following neurological injury( Jutaietal.,2007). Although a considerable number of studies have investigated the impact of assistive devices on walking ability(Alletetal.,2009;Baciketal.,2006; Hamzat and Kobiri, 2008; Maguire et al., 2010; Tyson, 1999; Tyson and Rogerson, 2009), to our knowledge there are no studies that have com-pared the training of gait with an assistive device to BWSTT or therapist facilitation. Studies comparing walking with and without the use of a gait assistive device have found that assistive devices, contrary to popular clinical opinion, can improve the quality and symmetry of gait performance in some individuals(Kuanetal.,1999;Laufer,2002;Tyson,1999; Tyson and Ashburn, 1994).Three dimensional quantitative gait analysis (3DGA) is the current criterion standard for evaluating gait performance.It has been used to evaluate BWSTT (McCain et al., 2008;Mulroy et al., 2010; Sousa et al., 2009), therapist facilitation(Lennon, 2001), and use of an assistive device (Kuan et al., 1999) following stroke. Although these studies have investigated the impact of each intervention on gait performance, we are unaware of any study which has systematically examined each of these gait training conditions. In the absence of a superior means for training gait following neurological injury, it may be useful to identify which condition most closely approximates normal able-bodied walking. 3DGA can be utilized to compare the three contemporary conditions of gait training to determine which approach is biomechanically optimal. The condition of gait training that most closely resembles the biomechanical pattern for able-bodied humanwalking may be the one that is most likely to optimize mobility outcomes. It may also be the condition that should receive more resources and development, and be targeted to identify factors associated with improved transfer of training gains.Therefore,the aim of this study was to determine which condition of gait training following acquired brain injury(ABI) best promotes normal able-bodied walking.
Gavin Williams, 1
Ross Clark, 2
Anthony Schache, 3
Natalie A. Fini, 4
Liz Moore, 5
Meg E. Morris, 2
and Paul R. McCrory 6
Abstract
Gait training is a major focus of rehabilitation for many people with neurological disorders, yet systematic reviews have failed to identify the most effective form of gait training. The main objective of this study was to compare conditions for gait training for people with acquired brain injury (ABI). Seventeen people who had sustained an ABI and were unable to walk without assistance were recruited as a sample. Each participant was exposed to seven alternative gait training conditions in a randomized order. These were: (1) therapist manual facilitation; (2) the use of a gait assistive device; (3) unsupported treadmill walking; and (4) four variations of body weight support treadmill training (BWSTT). Quantitative gait analysis was performed and Gait ProfileScores (GPS) were generated for each participant to determine which condition most closely resembled normal walking. BWSTT without additional therapist or self-support of the upper limbs was associated with more severe gait abnormality [Wilks’ lambda=0.20, F(6, 6)=3.99, =0.047]. With the exception of therapist facilitation, the gait training conditions that achieved the closest approximation of normal walking required self-support of the upper limbs. When participants held on to a stable handrail, self-selected gait speeds were up to three times higher than the speeds obtained for over-ground walking [Wilks’ lambda=0.17, F(6, 7)=5.85, p<0.05]. The provision of stable upper-limb support was associated with high self-selected gait speeds that were not sustained when walking over ground. BWSTT protocols may need to prioritize reduction in self-support of the upper limbs, instead of increasing treadmill speed and reducing body weight support, in order to improve training outcomes.Introduction
Gait training
is a major focus of rehabilitation for many people with neurological disorders (Harris and Eng,2004), with gait speed regarded as a good indicator of functional mobility (Schmid et al., 2007). Despite the considerable costs associated with being immobile and the large number of studies investigating the effectiveness of various gait training techniques, to date no regimen has been shown to be superior(Dickstein, 2008; Moseley et al., 2005; States et al., 2009; Wessels et al.,2010).Contemporary therapies for training gait fall into three main categories: (1) facilitation or assistance provided by a therapist, (2) gait-assistive devices, such as sticks, frames, and crutches; and (3) partial body weight support (BWS) provided by a harness suspended overhead.The most common means of providing partial BWS gait training, also known as BWS treadmill training (BWSTT), uses a harness to provide support and stability while the patient practices walking on a treadmill (Hesse, 2008). Reduced ability to walk and reduced walking speed fol-lowing neurological injury may be related to restricted opportunities to practice during rehabilitation (Bernhardt et al.,2008). Consequently,there has been much focus on BWSTT in recent years, because it provides the advantage of engaging in more task specific practice (Hesse et al., 1995), a term used to describe motor training that is context specific (Teasell et al.,2008). Task specific practice is the optimal approach for training motor skills(Dobkin,2004). Although included in the American Heart Association’s Definitive Stroke Guidelines(Miller et al., 2010), the efficacy of BWSTT remains unclear.Seven systematic reviews have investigated the effectiveness of BWSTT for people with neurological conditions and found little benefit from this approach, as training gains have not generalized well to over-ground walking (Dickstein, 2008;Marshall et al., 2007; Mehrholz et al., 2007; Moseley et al.,2005; States et al., 2009; Swinnen et al., 2010; Wessels et al., 2010). The most recent systematic review included six BWSTT and electromechanically assisted gait training studies in subacute stroke(Adaetal.,2010b). They reported that BWSTT(two studies) was more effective than over ground walking in achieving independent ambulation, despite the fact that this modality has little effect on gait speed. No reasons for the failure of the enhanced training times provided by BWSTT to improve mobility outcomes have been proposed.Randomized controlled trials investigating the effectiveness of BWSTT have usually compared outcomes to conventional gait training. Although conventional therapy may incorporate a range of strengthening, balance, and stretching exercises, conventional gait training usually involves thera-pist assistance or facilitation (Hesse et al., 1994, 1998; Hornby et al., 2008; Lennon, 2001; Moseley, 2005). Therapist facilitation may vary considerably between rehabilitation centers and between therapists with different levels of experience. A perceived advantage of therapist facilitated gait training isthe ability to continually adapt the assistance provided in response to the person’s performance from stride to stride(Lennon, 2001). Whether or not therapist facilitation is a more effective strategy than other gait-training conditions remains unclear.The use of assistive gait devices, such as walking frames,crutches, and canes, is common following neurological injury( Jutaietal.,2007). Although a considerable number of studies have investigated the impact of assistive devices on walking ability(Alletetal.,2009;Baciketal.,2006; Hamzat and Kobiri, 2008; Maguire et al., 2010; Tyson, 1999; Tyson and Rogerson, 2009), to our knowledge there are no studies that have com-pared the training of gait with an assistive device to BWSTT or therapist facilitation. Studies comparing walking with and without the use of a gait assistive device have found that assistive devices, contrary to popular clinical opinion, can improve the quality and symmetry of gait performance in some individuals(Kuanetal.,1999;Laufer,2002;Tyson,1999; Tyson and Ashburn, 1994).Three dimensional quantitative gait analysis (3DGA) is the current criterion standard for evaluating gait performance.It has been used to evaluate BWSTT (McCain et al., 2008;Mulroy et al., 2010; Sousa et al., 2009), therapist facilitation(Lennon, 2001), and use of an assistive device (Kuan et al., 1999) following stroke. Although these studies have investigated the impact of each intervention on gait performance, we are unaware of any study which has systematically examined each of these gait training conditions. In the absence of a superior means for training gait following neurological injury, it may be useful to identify which condition most closely approximates normal able-bodied walking. 3DGA can be utilized to compare the three contemporary conditions of gait training to determine which approach is biomechanically optimal. The condition of gait training that most closely resembles the biomechanical pattern for able-bodied humanwalking may be the one that is most likely to optimize mobility outcomes. It may also be the condition that should receive more resources and development, and be targeted to identify factors associated with improved transfer of training gains.Therefore,the aim of this study was to determine which condition of gait training following acquired brain injury(ABI) best promotes normal able-bodied walking.
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