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Debra Widmer-Reyes
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| Joined: | Tue Jun 10th, 2008 |
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Posted: Sat Feb 28th, 2009 04:48 pm |
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In the school setting, when performing a Walkable/Treadmill training session, i start with the most stable position in the harness as preferred by Mobility Research as a warm up for the first minutes of the session. ,Then, for 4-10 minutes, I do decrease the weight bearing support and allow for natural vertical movement as the student is challenged- i do a combo of independ. and facilitative gait training- i train for 10 steps, the student gets 10 steps, my turn-his turn, etc- then i return to the most stable position for the 2 minute cool down. Within the 4-10 minute training period, I also vary the speed or elevation or direction of walking- With this treatment plan, the students who "toe walk" "vault walk" or "laterally flip to shift wieght" has allowed the most change when the student is back over-ground. I also use forward placing mirrors to control head movement through visual fixation at a target.
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geomosley
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| Joined: | Mon Jan 12th, 2009 |
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Posted: Thu Feb 26th, 2009 09:27 pm |
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There's going to be some up and down movement anyway due to shifting of the harness, body tissue, clothing, etc. I would think this would only be an issue when unweighting a lot (>50%) which you don't want to do anyway. If the patient's stride length shortens noticeably or they come up on their toes during double support phase, then either loosen the Flexable or increase weightbearing by lowering the actuator. Either one will allow for that 5cm give.
Geoff
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LeoCat18
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| Joined: | Mon Jun 16th, 2008 |
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Posted: Sun Feb 22nd, 2009 02:20 pm |
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| In practical use, we do not have a flexable yoke as of yet. I am waiting for my facility to find funding for it. Most of my patients are very low functioning and I personally would keep it closed for much of the training that I do. The less extra movement the better. Also, most of my paitients are not going to walk over ground any time soon. As they get to a more normalized speed and more independent gait I would use the flexable yoke to give them the more normalized feeling of walking.
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nkarman
Instructor
| Joined: | Sat Jul 15th, 2006 |
| Location: | New York USA |
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Posted: Sun Feb 22nd, 2009 01:08 pm |
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The suspension system won't prevent vertical displacement if the patient's natural gait cycle produces it- to do that one would have to apply a downwardly-directed force on the individual's body preventing upward movement (the vertical displacement is most likely produced by the calf musculature in closed chain). Closing the flex yoke just doesn't facilitate that component of movement. I wouldn't worry about keeping it closed early on when control is the primary concern.
NK
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Lesley Smith
Instructor
| Joined: | Wed Aug 29th, 2007 |
| Location: | Humarock, MA |
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Posted: Sun Feb 22nd, 2009 03:25 am |
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From my Mobility Research training, if I understand correctly, the purpose of the flexible yoke is to allow vertical displacement during gait but for the lower level patients you want to initially minimize this as a way of providing the increased postual stability that they may require.
However, I have read recently in a couple of articles that vertical displacement of approx. 5cm is necessary for normal gait and that,
'Restriction of the pt's vertical center of mass movement.......may alter the the sensory experience of walking and, in turn, inaccurate sensory input, which is an important element of gait training in some patient populations." Martin et al. Body Weight Support Systems: Considerations for Clinicians. Physical therapy Reviews 2006; 11:143-152
Any thoughts?
Thanks,
Lesley
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