Gait Training: The Next Step

• By Laurie Watanabe
• Apr 01, 2010

Q&A with Lori Potts, PT, Rifton

Q: What conditions or diagnoses can benefit from gait training?

Lori Potts: Any child or adult who is unable to walk independently may benefit from gait training. Diagnoses include neuromotor impairments such as cerebral palsy and other developmental disabilities. In adult neurorehabilitation, gait training is appropriate for individuals who have had a stroke, traumatic brain injury or spinal cord injury that resulted in motor deficits affecting their ability to walk. Gait training can occur over a treadmill with a body-weight-support system, and/or gait training can occur over ground with a supportive gait device.

Q: What are the major goals of a gait-training program, besides the obvious goal of walking?

LP: The goals include improving an individual’s walking ability to progress them to increased independence in walking with the use of the least possible assistance. Progression from body weight support treadmill training (BWSTT) to over-ground gait-device training occurs with ongoing reduction of assist and support. This can result in either independent gait or independent walking with a cane, crutch or standard walker in both children and adults.

These functional gains through improved weight-bearing, core stability and balance may also result in increased independence and reduced assistance required for other activities of daily living, such as transfers. Improvements in gait balance, speed and individual confidence in walking can be achieved through gait training, even if complete independence from a device is not.

Q: What emotional, social and cognitive benefits can develop as a result of gait training?

LP: Gait activity provides an upright physical activity at eye-level with peers. The possibility of freedom of movement in natural environments has emotional and social benefits through the possibility of choice-making. For individuals with cognitive deficits, the possibility of learning through movement includes spatial awareness and motionbased cause and effect. Research is indicating that independent mobility at an early age may have a significant beneficial impact on cognition.

Q: How does a gait trainer work?

LP: There are many designs of gait-training devices. Essentially, these devices provide weight-bearing assist in some measure for individuals who cannot stand independently due to lack of weight-bearing ability through their lower extremities.

These devices also provide support that aligns the trunk and pelvis as needed to maintain the upright position and body balance over the individual’s base of support. Gait devices often include support for the upper extremities that serves as both weight-bearing assist and balance support. Further accessories assist leg positioning and alignment for step-taking. The amount of assistance and support can be decreased as the user gains skills and improves their independence in gait.

This article originally appeared in the April 2010 issue of Mobility Management.