Locomotor Training: Principles and Practice

Chapter 1 Evidence Based Practice and Activity Based Therapy for Recovery of Posture, Standing, and Walking I. Rehabilitation of Walking after Neurologic Injury or Disease: A Historical Perspective II. Recovery of Posture and Walking following Spinal Cord Injury 1. Functional deficits following spinal cord injury 2. Compensatory rehabilitation after spinal cord injury III. Recovery of Posture and Walking following Stroke 1. Functional deficits following stroke 2. Rehabilitation after stroke IV. Evidence Based Practice 1. Evidence-based, restorative strategies for rehabilitation after neurologic insult: Locomotor Training Chapter 2 Scientific and Physiological Evidence for Locomotor Training I. Neural Control of Locomotion a. Central Pattern Generation b. Interaction of Sensory Input with Spinal Cord Interneuronal Networks c. Activity-dependent Plasticity Task Specific Retraining II. Evidence of Sensory Processing by Human Spinal Networks III. Translation of Scientific Evidence into a Rehabilitation Intervention a. Activity-Based Therapy (Locomotor Training) i. Maximize weight bearing on the legs (Principle 1) ii. Optimize sensory cues (Principle 2) iii. Optimize the kinematics (i.e. trunk, pelvis, and lower extremities) for each motor task (Principle 3) iv. Maximize recovery strategies, minimize compensation strategies (Principle 4) b. Clinical Evidence for Functional Recovery in Spinal Cord Injury c. Clinical Evidence for Functional Recovery in Stroke d. Severity of Locomotor Impairment Chapter 3 Locomotor Training as an Activity-Based Therapy for Posture, Standing, and Walking IV. Compensation Based Rehabilitation to Activity-Based Therapy a. Compensation Approaches b. Activity-Based Therapy V. Locomotor Training Principles a. Maximize Weight Bearing on the Legs b. Optimize Sensory Cues Appropriate for Specific Motor Task c. Optimize Kinematics for each Motor Task d. Maximize Recovery, Minimize Compensation VI. Locomotor Training Therapeutic Components a. Step Training b. Over Ground Assessment c. Community Integration VII. Phases of Recovery a. Phase 1 b. Phase 2 c. Phase 3 d. Phase 4 VIII. Areas of Progression a. Endurance b. Speed c. Weight-Bearing (Load) d. Independence IX. Clinical Model a. Equipment b. Staffing c. Clinical Guidelines Chapter 4 Basic Skills for the Implementation of Locomotor Training I. Proper Attire, Harness Application, and Support Apparatus a. Proper Client Attire b. Applying the Harness i. Pelvic Belt Placement ii. Harness Vest Placement iii. Leg Strap Placement iv. Final Adjustments and Troubleshooting Harness Fit c. System Requirements d. Positioning the Client on the BWST II. Client and Trainer Positions during Standing a. Client Position b. Hip Trainer c. Leg Trainers III. Client and Trainer Positions during Stepping a. Client Position b. Hip Trainer c. Leg Trainers d. Alternate Hand Placements i. Reverse Hand Placement ii. Modified Standard Hand Placement Chapter 5 Basic Skills for Retraining the Nervous System I. Locomotor Training: The Step Training Component a. Step Retraining i. Weight bearing ii. Appropriate Kinematics iii. Appropriate Kinetics b. Step Adaptability i. Trunk Independence ii. Pelvis Independence iii. Leg Independence c. Stand Retraining i. Load Bearing of the Legs ii. Appropriate Kinematics d. Stand Adaptability i. Trunk Stability ii. Independent Pelvis iii. Leg Independence iv. Sit to Stand II. Team Roles a. Client b. Team Leader c. Hip Trainer d. Leg Trainer(s) e. Body Weight Support Treadmill Operator Chapter 6 Introduction to Over Ground Assessment and Community Integration I. Over Ground Assessment a. Trunk Stability b. Sit to Stand c. Stand d. Initiating Walking i. Upright Posture ii. Weight Shift e. Optimal Walking Pattern II. Community Integration a. Introducing Assistive Devices b. Trunk Stability c. Sit to Stand d. Stand e. Initiating Stepping and Good Stepping Chapter 7 Phases of Recovery I. Introduction to Four Phases of Recovery II. Abilities during Step Training a. Stand Retraining b. Stand Adaptability c. Step Retraining d. Step Adaptability III. Abilities during Over Ground Assessment a. Sit b. Reverse Sit Up c. Sit Up d. Trunk Extension in Sitting e. Sit to Stand f. Stand g. Walking IV. Goals by Phase of Recovery and Locomotor Training Component a. Phase 1 Goals i. Step Training ii. Over Ground Assessment iii. Community Integration b. Phase 2 Goals i. Step Training ii. Over Ground Assessment iii. Community Integration c. Phase 3 Goals i. Step Training ii. Over Ground Assessment iii. Community Integration d. Phase 4 Goals i. Step Training ii. Over Ground Assessment iii. Community Integration V. Appendix a. Phase Scoring Sheet b. Phase Sheet Cards Chapter 8 Progression to Recovery I. Introduction to Progression a. Four areas of progress i. Endurance ii. Speed iii. Load iv. Independence II. Progression by Phase of Recovery and Locomotor Training Component a. Phase 1 Progression i. Step Training ii. Over Ground Assessment iii. Community Integration b. Phase 2 Progression i. Step Training ii. Over Ground Assessment iii. Community Integration c. Phase 3 Progression i. Step Training ii. Over Ground Assessment iii. Community Integration d. Phase 4 Progression i. Step Training ii. Over Ground Assessment iii. Community Integration Index