Gait Training - II
Mazyad Alotaibi
Goals of Gait Training
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Increase area of support, maintain center
of gravity over support area
Redistribute weight-bearing area
Maximize functional independence and safety at
a reasonable energy cost
Requirements
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ROM, muscle strength and endurance,
coordination, trunk balance, sensory
perception, mental status
Amount of weight-bearing permitted on
lower limb
Gait aids
Preparation for Ambulation
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Review medical record
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Assess and know the patient’s problems and
abilities.
Establish goals and expectations
Determine selection, proper fit
Safety belt
Explain and demonstrate
Body Mechanics
Preparing the Patient
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Patients need to improve:
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Balance
Coordination
Flexibility (ROM)
Strength
Endurance
Major Muscle Groups
Upper Extremity
 Shoulder depressor – latissimus dorsi, lower
trapezius, pectoralis minor
 Shoulder adductor – pectoralis major
 Shoulder flexor, extensor and abductor – deltoid
 Elbow extensor – triceps
 Wrist extensor
 Finger flexor
Major Muscle Groups
Lower Extremity
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Hip Extensors
Hip Abductors
Knee Extensors
Ankle Dorsiflexors
Progression of Ambulation
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Initiate in Parallel Bars
 Maximum security
 Stability
 Safety
Explain to patient prior to beginning treatment
Demonstrate
Remain inside bars to assist
 decreases risk of injury (patient, self )
For PWB status, special devices may be used
Equipment
Purpose
 Increases stability by increasing BOS
 Decreases weight-bearing
 Permits mobility
 Decreases pain
Types
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Parallel Bars
Walkers
Crutches
Cane
Gait aids
Parallel Bars
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Maximum stability
No mobility
Adjustable
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Proper Fit
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20-250 elbow flexion
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greater trochanter
Walker
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Wider and more stable base of
support, but slow gait
For patients requiring maximum
assistance with balance,
uncoordinated
Add wheels to front legs for who
lack coordination or power in
upper limbs
Front of walker 12 inches in front
of patient
Shoulder relaxed and elbow
flexed 20 degree
Walker
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Types
 Standard
 Adjustable, Non-adjustable
 Reciprocal
 Stair-climbing
 Wheeled
 Folding
Proper Fit
 Grip at level of trochanter, wrist crease, or styloid process
 Feet of walker flat, even with heels
 Hips/knees straight, shoes on
Axillary Crutches
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Types
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Standard
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adjustable and nonadjustable
Offset
Triceps
Proper Fit
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3 fingerbreadths from axilla
Handpiece at level of greater trochanter, ulnar
styloid process, wrist crease
20-250 elbow flexion
Uses
 Unilateral non/partial weight bearing e.g.
fracture, amputee -> 3-point gait
 Bilateral partial weight bearing or incoordination/ataxia -> 2 or 4-point gait
 Bilateral weakness of lower extremities e.g.
paraplegia -> swing-to or through gait
Axillary Crutches
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Advantages
 Increased selection of gait patterns, speed
 Easily adjusted (wood or aluminum)
 Easily stored, transported
 Can use on stairs, crowded/narrow areas
Disadvantages
 Less stable than walker
 Can cause injury to axillary nerve, vessels
 Requires good standing balance
 Elderly insecure
 Functional strength of UE, trunk required
Crutch Gaits
Point gait – stability, slow
 Swing gait – more energy, fast
Four-point gait
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Good stability - at least 3 point contact ground
Ataxia or incoordination
Slowest, difficulty
Three-point gait/alternating
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Non-weight-bearing gait for lower limb fracture or
amputation
3-point PWB gait -> required 18-36% more energy per
unit distance than normal
NWB required 41-61%more energy per unit distance
than normal
Two-point gait
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Faster than 4-point gait but less stability
Decrease both lower limbs weight-bearing
Swing-through gait
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Fastest gait, requires functional abdominal
muscles
Required increase of 41-61% in net energy cost
(= 3-point NWB)
Swing-to gait
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Both crutches -> both lower limbs almost to crutch
level
Forearm Crutches
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Used when stability, support of axillary crutches
not required,
Requires more stability or support than cane.
Eliminates danger of injury to axillary nerves
and vessels
More functional on stairs
Easy to store and transport
Forearm Crutches
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Disadvantages
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Decreased stability
Requires good standing balance and good UE,
trunk strength
Difficult to remove
Elderly insecure
Proper Fit
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Cuff 1-1½ inches distal to olecranon
Canes
Body weight transmission for unilateral cane
opposite affected side is 20-25%
 Gluteus medius weakness, or pathological at knee
or ankle
 Cane eliminate necessary gluteus medius force
and reduces compressional force on hip
Proper Fit
 Measure tip of cane to level of greater trochanter,
elbow flexed 20-30 degree.
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Cane
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Uses
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Advantages
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Compensate for impaired balance
Increased stability
More functional on stairs, confined areas.
Easy storage, transport.
Disadvantages
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Provides limited stability
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decreased BOS