It might be difficult to define this word which appears very often in one doctor’s note. What does “Gait” mean? You must know this example: one of the human gaits is called “moonwalk”: Similar to backpedaling, the moonwalk is a walk in an opposite direction, but the subject seems to be stepping forward instead. The term moonwalk as a dance form was popularized by the late Michael Jackson in the mid 1980s. You may understand now that gait is the pattern of movement of the limbs of terrestrial animals, including humans, during locomotion. Most animals use a variety of gaits based on speed and terrain. This need requires tactic, and energetic efficiency.
Although the basic motor pattern is generated in the spinal cord, the detailed control of stepping and walking involves numerous regions of the brain, while some control the balance, others impact the modification of stepping by the visual signal… Two types of impaired motor control, which appear immediately after stroke, particularly will affect gait performance. It can either be paresis which is the weakness of the arm and leg, or the hyperactive stretch reflexes.
Traditionally, therapeutic methods to improve gait have included walking with essential walking aids and with verbal and manual guidance. The therapist will walk with the patient who requires mild to moderate assistance. The patient can also use a rigid support, like a hemi-bar, grasping with the unaffected hand, with the therapist standing on the paretic side and preventing the patient from shifting away from the bar.
Walking exercises are undertaken usually on the floor, but also in other circumstances such as on stairs or outside.
The step length can be then reinforced and increased over exercises. When step length is closer to normal, the subjects can be encouraged to walk faster and they can be timed for feedback. The step width can be reduced and the balance will be challenged by forcing the patient to walk along a line forward or walk sideways and backwards. The workload can be increased by making the patient climb stairs.
Besides the classic approach, other therapies are used as well. The treadmill which we always see in a gym has been used to enlarge the strategies recently, thanks to the training with partial body-weight support, combined with enforced stepping movements. This therapy consists of a period of interactive locomotor training on a treadmill in which weight support for the hindquarters (The posterior part of a quadruped) is provided. Scientists have shown that patients regain better walking ability by treadmill training with body-weight support plus physiotherapy.
There are other exercises supporting gait re-education after stroke. Improvement in balance is strongly correlated with improved gait, that’s why special balance exercises are usually included in other physiotherapy in addition to the walking exercises. The muscle strengthening and physical conditioning training also have positive impact on gait improvement.
Gait recovery is an important part in post stroke rehabilitation. Please consult your therapist for a tailored program with appropriate content.
Sources:
Stoke journal
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