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Debra Widmer-Reyes
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| Joined: | Tue Jun 10th, 2008 |
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| Posts: | 6 |
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Posted: Wed Mar 11th, 2009 11:55 am |
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Thank you for the interest- of course, you are picking a challenging case!!!!! Actually, i have found that visually all scenarios are the same! I do work with a neuro-optometrist, who prescribes prism lenses- although some of my parents choose not to use prism lenses primarily due to the drive and cost, i still see results. Advertising!! I do have a workbook just out at cliniciansview.com titled TAAP- that explains in detail. I am working with Mbility Research to produce some mirrors as well. But, for now, on the Tmill velcro plastic mirrors- when you are just waking or running, take 2 -8 x 10 or 9 x 11 mirrors and tape the ends together so they connect at appx 45 degrees- velcro the 45 degrees- this allows the student to view ambient info as she walks. Because the Tmill is fixed, the mirrors will start to provide an intense info stream of ambient clues for the brain to see wile the student is stable with regard to acceleration and motor. Most children with neuro diffs by this age have vis skills that are over-focalized. Focal- central vision processing information is detail and not rep of the whole so off the Tmill, info processed is in detail, thus fragmented, so students learn mobility thru envir by other ways- memory, mistake, your cues, very slow speeds. Ambient provides big picture cues and sets the template for focal detail. ambient-focal should be fused, but our kids (the brain) espec by 9yo block out ambient. With the mirror work, i see the head righting to a vertical (vestib righting) and students gait improving. It is so powerful that i hardly do any overground training anymore. I find the vertical head position carry over is hard with head tilts, but even my severe hemiplegic students who ignore their hemi side, have corrected their head tilt and their gait does as well. One of my hemi-girls in sitting would progressively tilt to the side so by end of day she would be out of her chair if we did not support her- she has been using mirrors for 2 1/2 school years- no summer work- Tmill 2-3 times a week for 15 minutes- now, she is NOT supported in her chair and her shoulders are 80% level thru the day-- Try it !!!The author i read most is Dr. Wm Padula.
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plor
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Posted: Wed Mar 11th, 2009 01:10 am |
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Yes. it does sound like we have another (fascinating) topic here regarding visual training for ambulation on and off the treadmill.
I am currently working with a 9 year old client with significant visual deficits. She is simultaneously learning to drive a power chair. I have been trying to coordinate with her mobility specialists at school and at the hospital (where she has power chair lessons) since I think consistency is important.
Obviously there are significant sensory differences when moving on the treadmill (while not actually moving through space), moving actively through space with a walker, and driving with minimal body movement.
I'm not sure if visual training on the treadmill can translate to the overground walking environment.
I for one would love to hear more input relating to visual training and vision use on and off the treadmill.
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Debra Widmer-Reyes
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| Joined: | Tue Jun 10th, 2008 |
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Posted: Wed Mar 11th, 2009 12:37 am |
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With regard to school, again!!!- i might be providing information that is not relative to the initial question of fitness- cardio-respiratory health, etc. Most/all students treated at school have significant impairments in order to qualify for services. So- most of these students i have on the treadmill have neurological developmental issues- it is my belief that with these developmental concerns, most students have visual processing errors. Simply stated, these v-p errors affect gross motor performance. When the students are on the treadmill, the visual pursuit and spatial knowledge can be trained using the structure of the litegait/treadmill and mirrors (providing focal and ambient input). The work out starts in a familiar pattern, even visually, then increases to challenges, then cool down. Part of the challenge time is the therapist changing the elevation or direction of walking while the student maintains vestibular head righting reaction to the postural demands of the changing belt. What i think happens-off Tmill, the student has difficulty visually directing gait, ramps, stairs- within a difficult visual environment- busy hallways, posters, artworks, distractions, etc. The "training" effect, i look for is for the student able to walk in the environment, off the Tmill, and visually negotiate the environment- it is those kids who have had intense visual training on the Tmill who do not regress, including over the long summer. These are students who are "exposed" to PE- even with pre-trained peers and collaboration their independent involvement in PE
is cautious, so may not be ever a time to affect traning in a fitness way. My toe walkers who corrected using a Tmill program before i used visual training, returned for more "time", my toe walker students with visual training have not returned, yet (3 years with a visual-gross motor protocol). So, I feel that the V-p errors are more involved with decreasing speeds than fitness parameters!
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plor
Instructor
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Posted: Mon Mar 9th, 2009 06:42 pm |
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Treadmill training is used with athletes to push speeds. If you're on the treadmill it is incumbent upon you to keep going!
Our kids are little athletes. If they are out walking by themselves they probably subconciously slow down, they stop TRAINING.
What are we training? cardiopulmonary as well as strength, endurance, gait patterns etc
If you pull your kids back to PT, who are slowing down, and test them, have they decreased in cardiopulmonary status (were you taking data regarding time, speed, distance, heart rate, breathing rate, recovery rates when they were doing their training the first time around?)
Do they need to get back on the treadmill to train or can they just be encouraged to develop their cardiopulmonary during PE classes? (you're at school, right?)
All of us get slower if we don't train on a periodic or ongoing basis.
Thoughts?
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Debra Widmer-Reyes
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Posted: Sat Feb 28th, 2009 04:29 pm |
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In the school setting, with regard to walking speeds, i design a "Litegait/Treadmill session" that has a warm-up, work out and cool down phase. I have had remarkable success (with regard to regression) once i started to follow this plan. The warm up phase is generally the activity that the student can perform well, the work out phase is the challenge and the cool down is the student's choice of activity. I learned the format from NDT experience. Change of direction is essential. I do not do any over ground training with the Walkable myself- I leave that for the Paraprofessionals and parents.
For example, 8 yo student with CRASH, non ambulatory, quadriplegic-
Warm up- with Walkable and harness- 2-4 minutes- combination of forward walk, changing speeds every count of 10, may change elevation as long as it is within warm up conditions.
Work out- 4-10 minutes-Walkable with handle bars, no harness, PT handling for gait training. Patterned walking- combinations of walking uphill, walk-run exchanges, backward steps and downhill walking
Cool down- 2-4 minutes, student choice, usually practicing independent standing or start and stops with the "clicker"- the emergency start, pause button.
I use forward placed mirrors for the student to develop visual processing skills while walking at all times. Short time changes in anything that can be changed- speed, elevation, breathing, counting steps, singing has dramatically changed my Litegait training.
At all levels the student must have some activity he can do independently. Initially, this program was repeated 2 x weekly with a PT, now it is performed 3-4 x weekly with a PT.
For the rest of his program, the Para performs an Walkable session for 15 -20 minutes daily within the classroom or building that is based on independent orienteering. All of his gait parameters continue to improve. Recently, hand surgery-casting, etc prevented effective training even though we thought we were creative to prevent it- from October08 to January 09- progress was slow to 0- once we returned to he above plan, it has been 3 weeks- 1st week before vacay, then vacay, then 3rd week and we are back. Before the Litegait/treadmill system-non related surgeries would be a big interruption! Just some ideas, Debra
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nkarman
Instructor
| Joined: | Sat Jul 15th, 2006 |
| Location: | New York USA |
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Posted: Sat Jan 10th, 2009 04:10 pm |
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I haven't done a literature search to back up this argument, however, I have pretty strong feelings about this issue. Neuroplastic changes go in both directions: use dependent cortical reorganization is one of the targets of intensive training. The counter to that would be "negative change," i.e. NOT using something will cause one to "lose" it. So, if the students are not practicing walking at faster speeds, then they will likely revert to slower walking speeds.
The faster walking speeds, however, do not necessarily have to take place in a body weight support system. One can practice fast walking over ground (i.e. be encouraged to walk at their maximum speed), although I have never been able to consistently get someone to walk faster over ground with verbal cues or tactile cues. The alternative is to continue fast walking on a treadmill without body weight support for those that can do so- this is a wholly appropriate component of a physical education program: try collaborating with the PE teachers (consistent with LRE requirements).
You should also consider factors that might make someone revert to slower walking speeds - weight gain, respiratory status/conditioning, etc. Maintaining appropriate levels of general activity (again, speak with PE teachers) is a necessary component following any motor gains.
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kdmpt
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| Joined: | Fri Jul 7th, 2006 |
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Posted: Wed Aug 20th, 2008 11:30 pm |
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Received this email from a PT using LiteGait at an elementary school:
Our program has really benefitted from having the litegait available for use. most of the users and their families have been thrilled to be able to access the litegait at their schools. we have been tracking walking speed and many of the kids have experienced an increase in walking speed after using the treadmill twice weekly for 6 weeks.
i do have one question. i have been tracking walking speed on a quarterly basis and am finding that the walking speeds are reverting back to pre-litegait training speeds within about 1/2 a year post training. do others find the same? do most children need regular use of the litegait to maintain improved walking speeds?
Please comment. Thanks!
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