Introduction:
"If you aren't treating your neuro patients like athletes, you are doing it wrong"
As discussed in our previous HIGT blog post, high intensity gait training is a crucial aspect of physical therapy that focuses on improving a patient's ability to walk with efficiency and stability.
To effectively integrate this training into your practice, how do you begin? New research by Mbaliki et al, in 2024 points access to knowledge in the specifics of HIGT is key to clinicians being comfortable enough to implementing the intervention. Article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11242475/
It is essential to master the cardiovascular demands as well as subcomponents that contribute to successful gait mechanics. In this blog post, we will delve into more of the specifics.
Cardiovascular Component:
In order to implement HIGT effectively, gait and step training with your patients must be vigorous enough to maintain their heart rate a certain range. Specifically 70-85% of their maximum heart rate, or 60-80% of their heart rate reserve. As you may expect, this means the patient's heart rate must be consistently monitored during the PT session.
In order to achieve these demands, not only will the patient participate in thousands of steps, but difficulty may have to by: increasing incline, introducing obstacles, adding stairs, etc. Per the Academy of Neurologic Physical Therapy (ANPT), this can often mean the patient will take about 4000 steps per session (about 4x the amount of conventional therapy).
Biomechanics subcomponents to consider:
Per the ANPT, therapists should consider the following biomechanical subcomponents during HIGT sessions:
Stance control refers to the ability to maintain an upright position during stance phase.
Why it matters: Stance control is fundamental for weight-bearing, shock absorption, and efficient propulsion. Inadequate stance control can lead to instability, falls, and decreased gait speed.
Limb advancement involves achieving step length and toe clearance
Why it matters: Limb advancement is essential for obstacle clearance, forward progression, and a smooth, symmetrical gait pattern. Impaired limb advancement can lead to tripping, decreased step length, and inefficient gait.
Propulsion refers to the ability to move the body in a specific direction during stance, which is separate from limb advancement
Why it matters: Propulsion is critical for maintaining gait speed and efficiency.
Maintaining stability in all planes & within the base of support
Why it matters: Postural stability is essential for balance and fall prevention. Impaired postural stability can lead to a wide-based gait, decreased speed, and an increased risk of falls.
The ANPT guidelines recommend to achieve this components with no more than 3-5 errors at one time. This can differ from conventional therapy, where the majority of a PT session consists of correcting the quality of gait.
The attached guideline from ANPT demonstrates some recommendations for emphasizing these subcomponents:
Conclusion:
Mastering high intensity gait training requires stress to the cardiovascular system of the patient, as well as an understanding by the clinician of the subcomponents that contribute to successful gait mechanics.
Remember:
- HIGT should be implemented gradually and progressively, considering each patient's individual capabilities and tolerance.
- Close monitoring and feedback are essential to ensure safety and optimize outcomes.
- Collaborate with the patient and/or caregiver to set realistic goals and track progress over time.
References:
Sharma A, Madaan V, Petty FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry. 2006;8(2):106. doi:10.4088/pcc.v08n0208a. PMID: 16830305; PMCID: PMC1470658.
Incorporating HIGT into Your Practice