Table 2 Tasks used to challenge balance during gait training
Task | Task Description | Task Progression |
|---|---|---|
Reducing Manual assistance | Participants using bilateral handheld assistance during walking are challenged to walk with unilateral handheld assistance that alternates between the left and right sides | Unilateral handheld assistance is gradually reduced to no external assistance |
Lateral stepping maneuvers | Physical therapist cues the participant to move from one side of the treadmill to the other by crossing a line projected along the length of the treadmill. Maneuvers are performed at varying speeds during forward walking | Increase the frequency of lateral maneuvers performed |
Head turns | Participants perform cued vertical and horizontal head turns while maintaining forward walking | Increase the magnitude and duration of the head turns |
Obstacle negotiation | Participants are asked to step over small objects (i.e., bean bags) during forward walking | Increase the frequency of obstacles with variable placement |
Altered stepping | Participants are asked to perform high knee marching or heel kick walking (maximal knee flexion during swing phase) | Modify the speed of the treadmill and minimize normal stepping between bouts |
Cognitive and visual focus dual task | Images (pictures, letters, numbers, etc.) are shown on a monitor mounted in front of the treadmill to divert participants gaze away from their feet. Participants also engage in various cognitive tasks related to the projected images and/or giving mathematical addition/subtraction tasks | Increase the speed of the changing images, increase the complexity of the cognitive task being requested (i.e., name object > name the letter that the object starts with > name the last letter of the object > spell the word) |
Walking with a narrow base of support | Participants are asked to walk on a straight line projected on the treadmill and continue to place foot ahead of each other | Participants are asked to perform tandem walking wherein toes of the first foot touch the heel of the next foot at each step |
Backward walking | Participants are asked to walk backwards | Walking speed is increased gradually, and additional balance challenges such as lateral stepping maneuvers, or altered stepping are added based on participants’ tolerance |