Publications
Addressing Resident Mobility and Fall
Prevention: A Clinical Perspective with Gait Training
by Joseph Millen, PT MTC
Case Studies
J.T. is a T11/12 incomplete 15
years post. He sustained both an SCI and above knee amputation
secondary to a MVA.. When he started the program a little over a
year ago at RIM, he had a wood prosthetic that was for static
standing only. He had not tried to walk in 15 years. His therapist
has progressed using the Gait Harness System (GHS) through 2
prosthetics/orthotics to a carbon fiber KAFO with stance control
knee and friction knee prosthetic. He has progressed to ambulation
with a standard walker plus stand by assistance for safety. He
currently is up to 1500 feet in the GHS and 600 feet with a rolling
walker. The therapist chose this individual because of the
complexity and the ease of application of the GHS with both a
prosthetic and orthotic.
A.B. is a C6 complete who had
been non ambulatory for over 10 years. She walks in the GHS with
carbon fiber KAFO’s. She only requires assistance for guidance of
the GHS. This would require more that one person without the GHS.
B.S. is a 6 foot 5 inch C5 ASIA
B status post diving accident. His therapist has progressed him
from KAFO’s to AFO’s. Additionally, the therapist has FES applied
to the tib anterior and pernoneals that he activates via a trigger
switch to break the extension spasticity. The GHS frees up an
individual to manually correct improper foot placement. The
therapist reports the harness works very well with the braces. This
particular individual also buckles on occasion. Generally this
happens when the patient accidentally activates the e-stim
bilaterally. The main point is that the GHS effectively prevents
him from falling and there is no pain or skin irritation from the
harness. The therapist reports this client has tried numerous
harnesses and said the GHS harness and the Crawl2@Walk crawling
harness are by far the most comfortable.
E. is a T6 complete. He now requires minimal assistance for
guidance of the GHS. He currently wears carbon fiber KAFO’s with
stance control knees. The Gait Harness works great with the
braces.
C.H. is a C6 complete. She is
status post MVA in 2002, and nasal tissue stem cell surgery in 2005.
She has therapy 3 x wk. In therapy, C.H. can walk 134 feet around a
track with leg braces and the GHS, with help from her therapist.
L.B. is a C8 tetraplegic, ASIA
A, status post MVA 10 years ago. She attends therapy 3 x wk, 3 hours
per session. L.B. uses bilateral carbon fiber stance control KAFOs
and a GHS. The two products work together to provide L.B. the
opportunity to safely ambulate with a natural reciprocating gait
pattern. Since her accident, she has regained some movement and
sensation below the level of her injury, much occurring since she
started in the SCI program. L.B. has purchased a GHS to be used at
home along with the braces. Her husband assists her with a sit to
stand into the GHS. Her home therapy program includes neuromuscular
E-Stim of all major muscle groups below the lesion level every other
day, and standing in the KAFOs and GHS to work on endurance,
pre-gait and gait activities.
A.F. is a T8 complete, status
post MVA in 2002, and nasal tissue stem cell surgery in 2005. A.F.
participated in a SCI program post stem cell surgery. Prior to
surgery, she was using non-stance controlled leg braces. Therapy was
3 hours daily. She is currently using stance controlled KAFOs, which
allow her legs to move independently within the GHS. The GHS forces
her to place most of her 122 pounds on her legs instead of her arms.
She is currently progressing by doing therapy at home, walking with
the GHS daily.
8 y/o pediatric male status
post high speed MVA with incomplete Spinal Cord T4 injury. He is
progressing to ambulation with a walker.
16 y/o pediatric male with
incomplete SCI. He is increasing his gait endurance and still comes
as an outpatient.
55 y/o with SCI and LE
paralysis went from walking 5 minutes moderate to maximal assistance
in the parallel bars to 45 minutes in the GHS independently after 1
week. After one month of therapy, he had improved lower extremity
circulation and substantially reduced risk of having his legs
amputated secondary to circulatory dysfunction.
K.M. is a 35 y/o male who
sustained a TBI as an 11 y/o child, status post MVA 24 years ago. He
had been wheelchair bound for 22 years at the time he first began
using the GHS in an adult day center program. K.M. began using the
GHS 2 years ago, but required 4 person assist and walked just a few
steps. He had moderate to severe tremors, and was barely able to
stand. Therapy has typically been 2 x week. One year later, he had
decreased to a 2 person assist, and was able to routinely walk up to
200 feet in the GHS. This current year, he is down to just a 1
person assist with ambulation in the GHS, and is routinely walking
400-450 feet per therapy session. His initial focus in therapy was
on distance and endurance. Now, he is also focusing on improving his
technique and self correction of form. He is finding it easier to
transfer into the GHS. K.M. is showing more stride confidence. He is
now able to look at pictures in hallways while walking. Tremors are
decreasing, and he is increasing control of his upper torso, head
and neck while walking. He is taking less frequent rest stops and
finding it easier to initiate initial stepping. Staff members
encourage him to bring his shoulders backward, tilt hips and pelvis
forward, and take smaller steps. His thigh muscle mass and strength
have increased so much he now requires a larger gait harness. K.M.’s
home caregiver reports he is much stronger and better able to assist
her with transfers at home. After seeing his steady improvement,
staff and other program participants are highly motivated to use GHS
for a variety of gait and balance dysfunctions.
This patient
sustained a TBI 8 years ago and is a long-term resident. He has
very little trunk stability so needs to walk with some assistive
device or he loses his balance. He has developed bad habits over
the last 8 years. When he walks, the therapist has been teaching him
to ambulate within the GHS upright and to correct gait deviations.
His progress is much slower but he is able to walk with more control
and stability within the system.
This patient sustained a TBI in June 2003.
This patient has been seen for a couple of weeks and already has
progressed out of the GHS and now walks with a rolling walker. He
is now able to transfer and walk independently with the walker
around the unit. The therapist was able to work with his balance
deficits and he was able to regain his balance very quickly. The
therapist also has placed resistance tubing around the thigh cuffs
for resistance training. Second Step suggested beginning higher
level balance training with ball toss and cone activities as a
progression to patient’s program.
TBI/CVA patient with severe extensor
tone and was totally dependent with standing and ADL’s. Patient has
progressed to a level of min. to moderate assistance with sit to
stand with bed mobility. The GHS has allowed the therapist to work
on static strengthening/balance to foot placement with gait
retraining and now the patient is walking 400’ with min-mod
assistance. Both OT and PT working with this patient have stated
that the GHS has made progress possible for this patient and without
it progress would have been minimal.
60 y/o retired MD secondary to
Parkinson’s Disease had substantial improvement in gait with reduced
falls and improved gait pattern after 1 month of skilled therapy.
55 y/o with SCI and LE paralysis
went from walking 5 minutes moderate to maximal assistance in the
parallel bars to 45 minutes in the GHS independently after 1 week.
After one month of therapy, he had improved lower extremity
circulation and substantially reduced risk of having his legs
amputated secondary to circulatory dysfunction.
25 y/o with TBI from overdose had
significant improvement in overall balance and coordination
patterns. She had significant dyskinesia that made ambulation a
high risk. In the GHS she was low risk of injury to herself and to
the treating therapist.
A bilateral amputee patient in the
nursing home setting had substantially improved gait pattern with
orthoses and shortened rehab stay while reducing the risk of falls
while in the GHS.
65 y/o with a history of a CVA and
bilateral TKA had return of functional gait and became independent
with a cane after 2 months of rehab one hour per day, three days per
week using the GHS and performing neuromuscular re-education
activities.
A 34 y/o male who sustained a TBI in
1994. Patient was at the Tampa VA for therapy from 1996-1997 and
recently returned in 2003 for a re-evaluation and was trained in the
GHS. The family was educated in the proper set-up and application
of the GHS and a request was made to have a unit shipped to
Tennessee for patient to use in the home for continuity of care and
continued functional training. Patient is currently max assist for
ADL’s and mobility, ambulates within the GHS 25’x 1 with assistance
before requiring a rest break, and his standing balance is poor.
This patient is in the GHS approximately 6x/week at this time. This
is an ongoing case study that started 12/18/03.
