Coordination of dynamic balance during gait training in people with acquired brain injury.
OBJECTIVE
To investigate movement of the center of mass (COM) during different gait training methods in people with neurologic conditions.


METHODS
Coordination of the gait cycle, represented by mediolateral COM displacement amplitude, timing, and stability, was assessed during a variety of gait training methods performed in a single session.


METHODS
Gait laboratory.


METHODS
People who were unable to walk unassisted due to an acquired brain injury (n=17) and healthy control subjects (n=25).


METHODS
The participants performed 7 alternative gait training methods in a randomized order. These were therapist manual facilitation, the use of a gait assistive device, treadmill walking with handrail support, and 4 variations of body weight-support treadmill training with combinations of handrail and/or therapist support.


METHODS
Mediolateral COM movement was analyzed in terms of displacement amplitude (overall range of motion), timing (relative to stride time), and stability (steadiness of the movement). Normative values for these measures were acquired from 25 healthy participants walking at a self-selected comfortable pace.


RESULTS
Body weight-support treadmill training without any additional support resulted in significantly (P<.05) greater amplitude, altered timing, and reduced movement stability compared with nonpathologic gait. Allowing handrail support or therapist facilitation reduced this effect and resulted in treadmill training (± body weight support) having lower movement amplitudes when compared with the other training methods. Therapist manual facilitation most closely matched nonpathologic gait for timing and stability.


CONCLUSIONS
In the context of overall dynamic gait coordination, no single method of training provides the optimal stimulus. A training program that uses a variety of techniques may provide a beneficial rehabilitation response.
Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia. raclark@unimelb.edu.au
Ross Allan
RA
Clark
Gavin
G
Williams
Natalie
N
Fini
Liz
L
Moore
Adam Leigh
AL
Bryant
D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D016022:Case-Control Studies; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D012656:Self-Help Devices; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*