None — Gait
Gait refers to a person's walking pattern. In humans, the gait cycle is measured from the first heel strike to the second heel strike. There are two phases – the stance and the swing. According to the Encyclopedia of Nursing and Allied Health, short people tend to take smaller steps in a faster rhythm, while taller people take larger steps in a slower rhythm.
Gait problems can lead to difficulty walking and increase the risk for falls. Some common causes of gait problems include: muscle weakness, spasticity, stroke, spinal cord injury or deformity (congenital or acquired).
Improving Gait
Gait training aims to improve the ability to walk with speed and efficiency while reducing the risk for falls. Traditionally, the training is done with two physical therapists, one of each side of the patient. The therapists take turns moving the patient's legs up, down and forward, following a natural walking pattern. This trains the patient's muscles and brain to follow the pattern, enabling gait to become more natural. Teresa Cramer, Physical Therapist with TIRR Memorial Hermann, in Houston, TX, says while traditional gait training can be effective, it is very labor intensive and therapists need time to rest after several minutes.
Some centers are now using a robot-assisted walking therapy system, called Lokomat®. The Lokomat consists of a motorized treadmill, special harness, robotic frame, straps and a computer. The patient is suspended in the harness over the treadmill and a robotic exoskeleton is attached to the legs by straps. When the device is activated, the treadmill moves. In tandem, the robotically-controlled exoskeleton moves the legs in a pre-programmed gait to match the speed of the treadmill in a natural walking pattern. The therapy is continuous, lasting up to 45 minutes, without any need for the therapists to take a break. Continual repetition helps patients learn or relearn a better walking pattern.
Lokomat® for Kids
Select centers are using a version of the Lokomat for children. According to the manufacturer, the Pediatric Lokomat has mainly been used for children with cerebral palsy, but can also be used for those with other types of gait problems.
The child-sized Lokomat is similar to the adult version, but with smaller legs and cuffs designed for a child's smaller body. In addition, the Pediatric Lokomat is tailored to enable a child to take smaller steps. A mirror on the Lokomat allows the child to see him/herself while taking steps, providing visual cues about body positioning during each step. In addition, some machines incorporate virtual reality or video games to provide motivation and incentives for the child to participate in the therapy.
The Pediatric Lokomat is designed for children four and older. Cramer says children generally start out with ten to fifteen minute "walking" sessions. Over time, session length and walking speed are gradually increased.
For information about the Lokomat system, click here.
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