Chapter 11: Gait Training in the Client With Hemiplegia

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Click here to view the Neurologic Lab Manual Videos Gait Activities and Progressions and Technique for Assisting Gait on the Treadmill.

OUTLINE

Objectives:

The student will appropriately:

1. Analyze gait as it relates to the client with neurologic impairment.

2. Demonstrate task setup and environment choice with appropriate use of equipment to optimize motor learning in gait retraining.

3. Demonstrate effective guarding skills in gait, including blocking hip, knee and trunk, and assisting swing during gait.

4. Utilize clear, concise verbal cueing and appropriate tactile cueing to provide sufficient but not excessive feedback.

Activity 1. Movement Analysis

Analyze the gait videos of Rick, Lynn, and Harold.

Activity 2. Manual Guidance, Cueing, and Feedback Demonstrations

Students practice manual guidance and facilitation techniques.

Activity 3. Gait Cases

Students practice treating two case study clients for functional losses related to gait. Students are to include:

1. Task

2. Environment

3. Feedback

4. Practice trials

5. Equipment

Activity 4. Stations: Assisting/Handling Techniques

Students practice in pairs techniques to use when having to manually assist a client during gait.

WORKSHEET

Introduction

When thinking about how a client learns to walk after stroke, one might consider the level of acuity of the client. Initially, in acute care, the client has a need to reorient to the vertical and to gain necessary postural control in standing. As he/she progresses, the client needs to learn the necessary balance and trunk control for stepping. As walking becomes more automatic, the physical therapist (PT) must train walking in a safe and efficient way to allow the client access the variable environments in his/her community. Along this continuum, a PT must consider the impact of the client's gait deficits on his/her participation in daily life.

Typical Gait Requirements:

• What does each leg need to do in order to maintain body upright?

• At what stage of gait is balance most challenged?

• What part of the gait cycle advances the body forward? What must happen in this stage to move forward?

• What is necessary at the end of stance phase to move forward?

The causes of atypical gait fall within what broad impairment categories?

Activity 1. Movement Analysis

Analyze the gait videos (Videos 11-1, 11-2, and 11-3)

Analysis: Describe the gait pattern exhibited by the individual in the video. Identify all deviations from a typical pattern.

Body Structure/Function: Hypothesize a list of impairments in ...