When was the last time you heard a patient say "I don't need a cane" or "I can walk without a walker?" If you work in the area of balance rehabilitation, you probably hear it everyday, if not multiple times a day. Should you take your patients at their word and cast aside their waking aids?
From the patient's perspective, they are finally starting to feel confident on their feet, which is good. This is why they work hard in therapy. Progress is great. However, they may be short sided in making such solo gait proclamations. They may be rushing the transition away from their cane or walker.
Under ideal conditions (flat, level floors and controlled environments), patients may feel steady and confident. But what happens when conditions are not ideal? As a therapist, you are likely thinking about all the different gait challenges. Surfaces are seldom hard and flat, rather uneven and variable. Obstacles often appear out of nowhere, including cords, pets, door thresholds, and clutter, to name a few. Quick turns, starts, and stops are frequently needed to avoid collisions (recall your last trip to the grocery store). And when unavoidable, collisions require the patient to withstand unexpected bumps or nudges to prevent falls.
Though patients often think of the one way everything can go right (ideal walking conditions), it is our job as therapists to consider and prepare them for all the ways things can go wrong (gait challenges). How good is their balance when conditions are not ideal? How steady are they on their feet when gait challenges are introduced?
The following 10 gait exercises will help you and your patients see how balance is affected by common gait challenges. They will also help better prepare your patient to safely go sans cane or walker.
1. Gait - Back Steps
2. Gait + Head Movements (Tilts or Turns)
3. Gait + Eyes Closed
4. Gait + Soft Surface
5. Gait + Resistance
6. Gait On Slope
7. Carrying Stable Object
8. Gait Around Obstacles
9. Gait On Obstacles
10. Gait Over Obstacles
About the Author: Shane Haas is a Physical Therapist with 20+ years of experience in the area of balance rehabilitation. He currently serves as Director of Rehabilitation at New Braunfels Regional Rehabilitation Hospital in New Braunfels, TX. He is also President and co-founder of ADL 365 Inc. (www.ADLbalance.com), a company that invents, tests, and makes exercise products by therapists for therapists. Shane can be reached at firstname.lastname@example.org.