Aspen Kunisch from Denver, CO asked:
This is slightly off topic - so you don't have to address during this presentation..but I am wondering if you are focusing on gait speed, how essential is not holding on. Is it better to allow holding on and increase speed as much as possible OR go as fast as you can but never let them hold on.
ANSWER: It depends on your primary objective of the moment… There is no simple answer to this question…
My bias is to avoid holding on, or at least to avoid weight bearing on the upper extremities (e.g. holding on to bungees or theraband, or overhead onto the yoke), even at the expense of walking speed initially, because I want to elicit the most normal gait pattern that I can: because the normal gait pattern is the most energy-efficient, and any deviation from that will ultimately be more energy-consuming. If the gait pattern is efficient, it is easier to build up speed over time.
That being said, I do sometimes have the person hold on for brief periods if that allows them to pick up speed, if, for example, I want to magnify sensory input, or increase stride length but then I don’t progress further until the person can perform that without holding on (even if I have to increase the amount of BWS to get them to be able to let go).
If they hold on, I prefer that they hold on to the yoke overhead, rather than the handlebars, if possible, since they can’t replicate that movement using an assistive device overground, and it promotes a more upright posture. In general, it is a balancing act of “what am I trying to accomplish/what is most important right now…” with a lot of give-and-take and in-line problem-solving/adjustments.
Last edited on Thu Nov 10th, 2011 06:47 pm by nkarman