Manipulating Biomechanical Subcomponents

As stated in a previous blog post the document from the Academy of Neurologic Physical Therapy (ANPT), "Biomechanical Subcomponents Explained," (click link to view document) provides an in-depth look at the various components to be manipulated during high intensity gait training. In this blog post, we’ll summarize the info and share video resources.

Video Resources from ANPT:

The ANPT does an excellent job of providing complimentary HIGT resources, including case studies. Below is an example of a case study to provide visuals of some treatment ideas during HIGT interventions.

You can view their entire playlist here: 

Examples for Manipulating the Subcomponents of Gait:

The subcomponents are broken down to cue the therapist to certain aspects of the patient's gait when implementing HIGT. The main subcomponents with treatment examples include:

1. Stance Control: Does the patient struggle maintaining their mass on the affected leg?

• Can assist with external supports (bodyweight support, Swedish knee cage, etc) or with assistance from the clinician
• Can intensify this subcomponent by adding adding weight/force to the patient or by encouraging them to bear weight on the affected side with stair navigation.

2. Limb Advancement: Is the patient struggling clearing their affected side during swing phase?

• Can assist with external wraps, bracing, or external supports (bands)
• Can intensify with external force during swing (ankle weights, resistance band behind patient's affected leg), or engagee in stair navigation to encourage a larger swing phase
• *Note*: AMBLE robotic can reduce foot drop impairment and be worn during HIGT

3. Propulsion: Can they move in a direction during end of stance phase?

• Can assist with manual assistance from clinician or by external force
• Can challenge propulsion with posterior directed force at the pelvis, with the patient pulling a sandbag or similar load, or by simply increasing the speed of ambulation

4. Postural Stability: Can the patient remain upright?

• Can assist with bodyweight support or clinician support
• Can challenge with variable tasks, virtual/augmented reality, compliant surfaces, or external perturbations

Conclusion:

Effectively manipulating the subcomponents of gait involves a comprehensive understanding of biomechanics and individualized treatment strategies. By focusing on specific aspects physical therapists can significantly improve patients' gait patterns, enhancing their mobility and quality of life. The document from ANPT provides valuable insights into these biomechanical subcomponents, offering a solid foundation for tailoring interventions to meet each patient’s unique needs. 

For more in-depth guidance, be sure to refer to the full document (link below) for detailed explanations and advanced techniques. Happy treating!