**High-Intensity Gait Training: Safety Considerations for Physical Therapists(PTs)**

High-intensity gait training (HIGT) has emerged as a powerful intervention commonly used when patients have suffered a neurological event such as stroke, spinal cord injury, or traumatic brain injury. 

With HIGT designed to push the patient's limits to maximize improvements, this intervention comes with important safety considerations that PTs must be mindful of to ensure effective and safe treatment. A guideline document from the Academy of Neurologic Physical Therapy provides valuable insights into the vital signs and parameters that should guide HIGT. 

Key Safety Considerations

1. **Baseline Assessment**: Before initiating HIGT, a thorough assessment of the patient’s cardiovascular and musculoskeletal status is crucial. This includes evaluating their resting heart rate, blood pressure, and oxygen saturation. Any physician recommendations have precedent.

2. **Monitoring Vital Signs During Treatment**: The attached guideline document outlines specific parameters:

 (click here to see ANPT summary of safety considerations):

• Heart Rate (HR): Monitor for abnormal increases or decreases. The target HR should be within 70-85% maximum HR. Do not begin HIGT if heart rate is > 120 bpm at rest.  

• Blood Pressure (BP): Regularly check for significant changes. A sudden rise or drop in BP could indicate stress or an adverse reaction to the exercise intensity. Blood pressure should not be higher than 180/110 mmHg at rest or above 250/115 mmHG during activity.
• Oxygen Saturation: Should remain above 92%

3. **Signs of Intolerance**: Be vigilant for signs of intolerance, such as dizziness, shortness of breath, or chest pain. 

Conclusion

HIGT offers significant benefits for individuals with neurological conditions, but it is essential to prioritize safety to achieve optimal outcomes. Clinicians must be ready to alter the treatment based on the vital sign data. By adhering to the guidelines provided and incorporating vigilant monitoring and individualized care, physical therapists can effectively harness the power of HIGT while safeguarding their patients' health. 

For more detailed guidelines on vital signs and parameters during gait training, refer to the [guidelines](https://neuropt.org/docs/default-source/cpgs/locomotor/vital-signs-parameters_final167a38a5390366a68a96ff00001fc240.pdf?sfvrsn=d6795e43_0).

References: 

Academy of Neurologic Physical Therapy. Vital Sign Parameter Guidelines. [internet]. Washington University in St. Louis Program in Physical Therapy; 2018 [cited 2023 Oct 26]. Available from: www.neuropt.org