Prerequisites of Gait Training

in Neurological Rehabilitation
Gait Training or Gait rehabilitation
• Gait is a particular manner of moving on foot which may be a walk,
jog or run.
• Gait training\Gait rehabilitation is the act of learning\ re-educating a
patient how to walk, either as a child, or, more frequently, after
sustaining an injury to the brain, spinal cord or peripheral nerves
emerging from them.
Some Prerequisites

• Comprehensive Assessment:
• Medical Stability:
• Muscle Strength and Endurance:
• Range of Motion and Flexibility:
• Coordination and Motor Control:
• Visual and Vestibular Considerations:
• Mobility Aids:
• Individualized Treatment Plan:
Comprehensive Assessment:

Before initiating gait training, a thorough assessment of the patient's neurological condition is
crucial. This includes evaluating the nature and extent of the neurological injury, understanding the
patient's medical history, and identifying any associated impairments affecting mobility.

e.g
I. Level of Consciousness
II. A Stroke pt.
Patients Stability:

Medical stability is a critical prerequisite for gait training. The patient must be in a stable medical
condition to participate safely in rehabilitation. This involves managing any acute medical issues,
ensuring vital signs are within normal ranges, and confirming that the patient is medically fit to
engage in physical activity.
• E.g
• Acute Medical Issues:
I. Infections
II. Pain Management
III. Vital Sign Monitoring:
Muscle Strength and Endurance:
Assessing muscle strength and endurance is fundamental. Neurological conditions often lead to
muscle weakness or paralysis, impacting the ability to walk. Rehabilitation aims to address these
issues through targeted exercises to improve muscle strength and endurance by assessing muscle
strength and functional activities.

For example
• Stroke: Depending on the location and severity of the stroke, muscle weakness can affect one or
both sides of the body, impacting gait symmetry and balance
• Guillain-Barré Syndrome (GBS): This autoimmune disorder affects the peripheral nerves,
leading to progressive muscle weakness that can initially involve the legs and progress upwards.
Range of Motion and Flexibility

Limited joint mobility and flexibility can affect proper gait. Assessing and addressing the range of motion in
joints is vital. Rehabilitation focuses on enhancing flexibility through specific exercises and stretches to facilitate
a more natural and efficient walking pattern.

• Joint stiffness: This can occur due to various factors, such as muscle weakness, spasticity, or scar tissue
formation, limiting the movement of joints in the lower limbs and trunk.
• Contractures: In severe cases, prolonged joint stiffness can lead to contractures, which are fixed limitations
in joint mobility. This can significantly hinder the ability to perform activities like walking.
Coordination and Motor Control

Neurological injuries can disrupt coordination and motor control, affecting the ability to execute
smooth and coordinated movements required for walking. Gait training interventions target
improving coordination and motor control through specialized exercises and activities.

Example of Coordination and Motor Control Deficits in Neurological Conditions:

• Stroke: Depending on the affected brain region, individuals with stroke may experience:
• Ataxia: Clumsy and uncoordinated movements due to impaired balance and coordination.
• Hemiparesis: Weakness on one side of the body, impacting gait symmetry and coordination.
Visual and Vestibular Considerations

• Visual and vestibular functions play a crucial role in maintaining balance and coordinating
movements during walking. Assessing and addressing any visual or vestibular impairments
is essential in neurological rehabilitation for gait training to enhance overall stability
Visual and Vestibular Impairments in Neurological Conditions:
• Stroke: Depending on the location of the stroke, individuals may experience:
• Hemianopia: Blindness in half of the visual field, impacting their ability to see obstacles on one side.
• Visual neglect: Difficulty attending to one side of the visual field, potentially leading to unbalanced gait
patterns.
• Parkinson's Disease: Individuals may experience:
• Postural instability: Difficulty maintaining upright posture due to impaired sensory input from the
vestibular system.
• Freezing of gait: Sudden inability to initiate or continue walking, potentially triggered by visual cues.
Mobility Aids

Selecting and providing appropriate mobility aids, such as canes, walkers, or orthoses, is
part of the gait training process. The choice of aids depends on the individual's specific
needs and level of impairment, promoting safety and independence during walking.
• Examples in Neurological Conditions:
• Stroke: Depending on the severity of the stroke, individuals may require:
• Canes: For mild balance impairments or gait deviations affecting one side.
• Walkers: For individuals with more significant balance deficits or weakness on one side.
• Parkinson's Disease: Stiffness and rigidity can affect balance and gait initiation.
Individuals may benefit from:
• Rolling walkers: Offering support and a platform to rest briefly during walking episodes with
freezing of gait.
• Ankle-foot orthoses (AFOs): Supporting the ankle joint and improving stability during walking.
Individualized Treatment Plan

• Developing an individualized treatment plan is paramount. Each

patient's neurological condition is unique, requiring a tailored
approach to rehabilitation. The treatment plan should address the
specific challenges identified during the assessment and focus on
progressive goals for gait improvement.
• Parkinson's Disease: A patient with Parkinson's Disease experiencing
freezing of gait might have a treatment plan including cueing
techniques, such as visual or auditory cues, to initiate walking,
practicing walking through doorways to improve turning ability, and
utilizing an ankle-foot orthosis (AFO) to enhance stability and prevent
falls.
Continue
• Stroke: A patient with stroke-related hemiparesis might have a
treatment plan focusing on strengthening the weak leg muscles,
improving balance through weight-shifting exercises, and practicing
walking with a cane as a goal to regain independence in transferring
from bed to chair.
• Multiple Sclerosis (MS): An individual with MS experiencing fatigue
and mild leg weakness might have a treatment plan emphasizing
endurance training, incorporating short walking intervals with rest
periods, and practicing safe gait patterns with a walker to maintain
mobility despite fluctuating symptoms.