What is Gait training?

Gait training is learning how to walk in part or whole. Many people require gait training with diagnosis ranging from mild injury to major neurological disorders. Some of the most common reasons to seek gait analysis from a physical therapist is pain. Patients may experience pain in any number of body parts, and walking may aggravate the pain. The obvious and logical assumption is that the manner in which one walks is related to the pain. Patients often express  a great deal of surprise when analysis reveals poor patterns that were likely present for many years.

It can be quite difficult for a patient to  alter the manner or mobility that one has become accustom to over the many years of life. Remember walking begins between 7 and 15 months and it becomes a firm habit by age 7, with most people solidifying the manner of gait at that young age. The lower portion of the brain is responsible for the gait pattern as it becomes a somewhat unconscious behavior. A practical example of how a lower brain function can be superior to a higher brain function is the athlete. An athlete is “a person trained or gifted in exercises or contests involving physical agility, stamina, or strength; a participant in a sport, exercise, or game requiring physical skill” (dictionary.com). The athlete learns a particular sport and becomes so adept at the movement that he or she can perform the required skill without thought, that is to say, with the lower brain function. Often when placed under pressure or attention is called to the task the athlete “over thinks” the movements and performs poorly.  

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(Increases in step width have been reported for several clinical populations, including older adults and stroke survivors. These populations often also exhibit decreased hip abductor strength, suggesting that walking with wider steps may be an adaptive response in order to reduce the mechanical demands on the hip abductors. The purpose of this study was to quantify the relationship between step width and gluteus medius (GM) activity during walking. Fourteen young, uninjured adults walked on a treadmill at 1.25m/s for four step width conditions (Normal, Narrow, Medium, and Wide) while step width and stance phase GM electromyographic (EMG) activity were quantified. We also measured hip abduction torque and GM activity during maximum voluntary isometric contractions (MVICs) at three hip angles (neutral, abducted 10°, and abducted 20°). During walking trials, GM activity was significantly (p<0.0001) influenced by step width; compared to Normal walking, GM activity was 47% higher with Wide steps and 24% lower with Narrow steps. We also observed a weak positive correlation (r=0.18±0.14) between step width and GM activity during Normal walking, as GM activity was higher with wider steps. These results cannot be attributed to changes in GM conformation under the recording electrode, as GM activity was not influenced by hip angle during MVICs. The increased GM activity with wider steps does not support the proposal that increasing step width would be a beneficial adaptation to weakened hip abductors. A likely alternative explanation is that increased step width is a response to decreased gait balance) Kubinski, SN. Walking with wider steps increases stance phase gluteus medius activity. Gait Posture. 2014

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