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Chapter 11: Gait Training

CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

  1. Describe the various gait parameters

  2. Describe the characteristics of normal gait

  3. Discuss how to use the various pieces of pre-ambulation equipment, including the tilt table and parallel bars

  4. Describe the various types of weight-bearing status and the functions of each

  5. Describe the various methods to monitor the weight-bearing status

  6. Make a clinical decision as to how well an assistive device is assisting a patient

  7. Be able to fit a patient for an assistive device

  8. Discuss the importance of patient safety during gait or ambulation activities

  9. Provide training to the patient on how to use an assistive device during various transfers

  10. Teach a patient how to use an assistive device with varying gait patterns, during stair negotiation, and ambulation in the community

Figure 11-13, Figure 11-14, Figure 11-15, Figure 11-16, Figure 11-17, Figure 11-18, Figure 11-19, Figure 11-20, Figure 11-21, Figure 11-22, Figure 11-23, Figure 11-24, Figure 11-25, Figure 11-26, Figure 11-27, Figure 11-28, Figure 11-29, Figure 11-30, Figure 11-31, Figure 11-32, Figure 11-33, Figure 11-34, Figure 11-35, Figure 11-36, Figure 11-37, Figure 11-38, Figure 11-39, Figure 11-40, Figure 11-41, Figure 11-42, Figure 11-43, Figure 11-44, Figure 11-45, Figure 11-46, Figure 11-47, Figure 11-48, Figure 11-49, Figure 11-50, Figure 11-51, Figure 11-52, Figure 11-53, Figure 11-54, Figure 11-55, Figure 11-56, Figure 11-57, Figure 11-58 are reproduced with permission from Dutton M: Introduction to Physical Therapy and Patient Skills, 2nd ed. New York, NY: McGraw Hill; 2014.

OVERVIEW

It is not clear whether gait is learned or is preprogrammed at the spinal cord level. However, once mastered, gait allows us to efficiently move around our environment, requiring little conscious thought, at least in familiar surroundings. On the surface, gait appears to be a very simple task where the lower kinetic chain has two main functions: to provide a stable base of support (BOS) in standing and to propel the body through space with gait allowing the arms and hands to be free for exploration of the environment. Whereas the objective in standing is to maintain a static equilibrium of forces, the objective with mobility is to create and control dynamic, unbalanced forces to produce movement.1 So gait is a complex process that requires control of various neuromuscular, musculoskeletal, cardiopulmonary, and psychological factors to produce controlled instability, making it prone to breakdown.

POSTURE

The transformation of the human race from arboreal quadrupeds to upright bipeds is likely related to the need to have the upper extremities available for carrying a wider variety ...

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