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Publications
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- Second Step Gait Harness
System as Compared to Body Weight Support Systems
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- The Second Step Gait Harness System (GHS)
ambulator has several distinctions that make it
unique when compared to body weight support
systems.
First, the GHS does not directly off-load
the individual’s weight. Weight reduction (if
needed) is performed actively by the individual
in the System. Most individuals will not have
home access to a body weight support treadmill
training system, but may be able to implement an
over-ground system that allows for the efficient
reinforcement. I use the Gait Harness System,
which does not directly offload weight, to
accomplish this reinforcement (the individual
offloads as needed or instructed).
Second, the harness used in the GHS directs
supportive forces (or fall recovery forces)
through a much larger surface area on both
thighs. Other over-head harnesses direct these
forces through the sensitive pubic area, which
often leads to decreased treatment time and
intensity.
Lastly, the GHS allows for reinforcement of
newly learned gait patterns in a real world
situation. I have implemented this technique
with several incomplete Spinal Cord Injury
individuals and have had great success in
regards to gait speed and distance. This is a
very beneficial and much needed adjunct
treatment paradigm, and accentuates body weight
support treadmill training. Body weight support
treadmill training, in general, has shown a
benefit of retraining central pattern generation
and the ensuing stepping pattern. Body weight
support treadmill training can be difficult and
labor intensive. For body weight support
treadmill training to be effective, any progress
made needs to be safely reinforced with
over-ground training.
The GHS allows you to safely transfer and
reinforce this progression to various land-based
gait training activities. Reinforcement of the
various qualities of gait during land-based
activities is a must for the activity to become
functional.
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William Thornton, MPT
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Lead Physical Therapist
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Center for Spinal Cord Injury Recovery
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Rehabilitation Institute of Michigan
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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 is 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.
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 800 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.
P.D.
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.
S.B.
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 using the GHS.
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.
D.H.,
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. This patient uses
GHS daily at home.
