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amirseif
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Posted: Wed Aug 6th, 2008 11:17 pm |
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I agree with the reduced task specificity due to use of UE. If arms are doing anything during walking they should be swinging in time with the LE.
I also would like to point out the Chen article which seems to report an improvement due to UE use (holding on to the bar for support) indeed maybe slightly misleading. If you carefully read what they have found is an increased outcome due to increased BWS use. When UE support was added it furthered the improvement. It could easily have been due to increased BWS and/or stability.
The guiding principle in providing PWB-GT treatment has to be the correctness of the patterns, the normalcy of the afferrence, in short the quality of the practiced gait. If a patient needs to stablize and you do not allow it at the expense of poor coordination, you have broken the first rule of PWB. However, if the patient uses their UE to compensate in a manner not available to him while walking over ground, the task specificity of the practice is lost. Whn practicing intensive supported treadmill walking, we all have to be very careful not to let patient motor poor behavior
Last edited on Wed Aug 6th, 2008 11:32 pm by amirseif
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kdmpt
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Posted: Wed Aug 6th, 2008 10:41 pm |
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Those patients you referred to as "slouchers" need more facilitation and assistance from the therapist to achieve the ideal postural position. This usually means placing your hands on their hips/knees to bring them into an upright position. I often use my shoulder to push the hips forward and use my hands on the tibial plateaus to pull the knees into greater extension.
Depending on the patient, it may be helpful to increase the overhead support or be constantly changing the overhead support slightly so that the patient cannot predict it and therefore won't rely on it. Sometimes just increasing your treadmill speed will help.
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Moronke
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Posted: Wed Aug 6th, 2008 09:06 pm |
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The citation you are looking for is
Visintin M, Barbeau H. (1994) The effect of parallel bars, body weight support and speed on the modulation of the locomotor pattern of spastic paretic gait. A preliminary communication. Paraplegia, 32, 540-553.
Education Department
Mobility Research
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Eran S.
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Posted: Tue Aug 5th, 2008 06:04 pm |
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WHat about the "slouchers" those patient that tend to slouch into the harness and let it balance and support their weight instead of perform the weight bearing themselves?
Any usefull techniques out there?
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tpazier
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Posted: Tue Aug 5th, 2008 03:23 pm |
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Can you cite the studies showing decreased LE activation with UE support.
Thanks,
Tim Pazier
St. Joseph Medical Center
Tacoma, WA
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nkarman
Instructor
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Posted: Sat Aug 2nd, 2008 02:35 pm |
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Last edited on Sat Aug 2nd, 2008 02:41 pm by nkarman
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Lesley Smith
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Posted: Sat Aug 2nd, 2008 02:51 am |
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Work by Chen et al, "supported the use of a handrail hold to normalize the gait pattern practiced by hemiparetic individuals during locomotor training."
Although they reported that the effect of handrail holding during treadmill training, as a specific parameter, has not been examined, all the studies they looked at that reported improved gait symmetry and increased single limb support time on the paretic side, provided a handrail.
I haven't seen the firing pattern studies, but I must say I frequently observe how the UE can interfere with the firing pattern of the LE, both on/off the T-mill, with/without BWS. However, some patients can not focus on co-ordinating a reciprocal gait pattern without the security of UE support, in which case I allow it. Once they get their 'sea legs' then I wean them from the UE support before increasing speed/decreasing BWS.
Treadmill Training with Harness Support: Selection of Parameters for Individuals with Poststroke Hemiparesis. Chen G, Patten C. Journal of Rehabilitation Research & Development. July/August 2006. Vol 43, Number 4, 485-498.
Lesley Smith
RHCI
Sandwich, MA
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nkarman
Instructor
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Posted: Thu Jul 31st, 2008 02:21 am |
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| I find it helpful to give the patient "something" to hold onto that is really not a supportive device, and that would allow armswing. Theraband or bungee cords wrapped around the actuator and clipped/tied to the harness work well. They have something to hold onto, but not to hang onto.
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WebKeeper
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Posted: Sat Sep 22nd, 2007 06:28 am |
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- It should be avoided. If needed allow patient to begin by holding on and then gently wean them off UE support.
- Studies have shown that use of UEs changes the firing patterns of LE musculature.
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WebKeeper
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Posted: Sat Sep 22nd, 2007 06:26 am |
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Should a patient hold onto the handlebars during therapy? Last edited on Sat Sep 22nd, 2007 06:28 am by WebKeeper
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