Learning To Walk After A Spinal Cord Injury

People who have experienced a stroke or a spinal cord injury may need to relearn to walk. As they move through this process, high-intensity gait training helps improve their outcomes.

High-Intensity Gait Training vs. Traditional Gait Training

In traditional gait training, professionals focus on correcting your walking pattern. Typically, there are eight phases each leg has to move through to take each step. Each phase has specific movements or muscle actions that occur. A physical therapist should provide cues or guidance to complete the movement patterns.

For example, "Make sure you land on your heel" or "Make sure you kick your leg out."

High-intensity gait training is a walking and stepping practice that focuses on keeping your heart rate over a specific target or within a specific range. The set goals can be different from patient to patient.

"Having a patient walk at high intensities to reach fatigue forces the brain to find a way to save energy while walking," explains Sandy Lim, a physical therapist at Franciscan Health Indianapolis. "The brain goes, 'There must be a better way. We're getting too tired.' This leads to a more normal walking pattern because it saves energy." Lim compares it to how a baby learns to walk.

"At first, it looks nothing like normal walking. It's this very high steppage walk," Lim said. "After about five, ten feet, they squat and rest because they've worn themselves out. Over time, the brain figures out how much energy actually needs to be expended and babies develop into the normal walking pattern we see in most people."

Who Is a Good Candidate for High-Intensity Gait Training?

Any patient who has had a stroke, brain injury, or an incomplete motor spinal cord injury - and who was ambulatory before being hospitalized - may benefit from high-intensity gait training. The following factors can all play a role in determining who will have the best outcomes, including:

• Age
• Severity of the paralysis
• Cognition
• Sensation
• Sitting balance

"There's actually a lot of research now for factors for stroke and spinal cord injuries to determine if high-intensity gait training would be best for them," Lim said. "The physical therapist can help determine if the training is appropriate."

People who aren't good candidates include:

• Pregnant women
• Amputees
• People with significant cardiovascular history (e.g. heart attack plus stroke)
• People with a leg fracture
• People with weight bearing limitations

Preparing Patients for Daily Life

High-intensity gait training results in walking improvements, along with walking-related concepts like walking speed, quality, and symmetry.

Because walking is a higher form of movement, it also naturally improves balance, sit-to-stand movements, and out-of-bed mobility.

"We want to reflect real life and prepare the patient to return home," Lim said. "Typically, we do things in addition to walking. A lot of times we walk and carry our groceries. We walk and carry our lunch. We increase our walking speed to cross streets or catch the elevator. We walk outside in the grass and in gravel, and we have to be prepared for those kinds of surfaces. We walk and talk. Nowadays, a lot of us walk and text, though I don't recommend we do that."

Personalized Approach Optimizes Outcomes

Franciscan Health takes a very personalized approach to high-intensity gait training.

Each patient is assessed for their individual needs and the training is tailored to those needs. During training, patients are also monitored very closely. Research points to this training as a safe, effective therapy for eligible individuals.

"Currently, there's no research indicating there's any increased risk for high-intensity gait training or aerobic training beyond just the standard types of practice," Lim said. "By keeping the heart rate less than 85% of an age-predicted heart rate, that helps mitigate the risks. For some patients, if needed, physical therapists can also get clearance from the appropriate medical doctors to do high-intensity gait training."

Listen To Franciscan Health Physical Therapist Sandy Lim

Visit Radio MD to listen to an in-depth conversation with Sandy Lim about high-intensity gait training.