I. Pre-walking training
1.Definition: A series of training for patients to prepare for the completion of walking exercises, in order to improve the patient’s ability to adapt to standing and walking positions.
2.Indications and contraindications
(1) Indications: Patients with central paralysis, such as hemiplegia, paraplegia, cerebellar disorders, cerebral palsy, etc.; patients with motor system lesions affecting walking, such as prosthesis after amputation, hip replacement, etc.
(2) Contraindications: standing balance dysfunction; unhealed lower limb fractures; joint instability due to various reasons.
3.Equipment and appliances: muscle strength enhancement training device, parallel bars, rising bed, cane, crutches, etc.
4.Operating methods and steps
(1) Muscle strengthening training: for patients who need to walk with walkers or crutches, focus on developing upper limb muscle strength; for those who expect to complete independent walking, focus on lower limb muscle strength; for upper and lower limb amputees, stump muscle groups and abdominal muscle strength training are required; the amount and manner of training exercises refer to the contents of the “muscle strength training” section.
(2) Upright bed training: For patients with long-term bed rest or spinal cord injury, to prevent postural hypotension, use the upright bed to gradually adjust to an upright position. When the patient can tolerate the body upright, you can consider starting standing or walking exercises.
(3) Training within the parallel bar, cane, crutches standing training: according to the patient’s condition, use the parallel bar, cane, crutches for standing, weight transfer, unipedal support, in situ stepping or striding exercises, etc., in preparation for walking exercises.
5.Cautions
(1) The patient’s blood pressure changes should be noted during pre-walking training.
(2) A safe and barrier-free environment should be provided.
(3) The length of clothing should not reach the ground to prevent tripping.
(4) Wear appropriate shoes and socks with laces firmly tied, not barefoot.
II. Walking training
1.Definition: The patient himself or use different walking aids to practice walking ability.
2.Indications and contraindications
(1) Indications: central paralysis, such as hemiplegia, paraplegia, cerebellar disorders, cerebral palsy, etc.; patients with motor system lesions affecting walking, such as prosthesis after amputation, hip replacement, etc.
(2) Contraindications: serious impairment of standing balance; unhealed fractures of the lower limbs; joint instability due to various reasons.
3.Equipment and appliances: parallel bars, canes, crutches, walkers, walking frames, weight-reducing walking devices, walking robots and wheelchairs, etc.
4.Operating methods and steps
(1) Parallel bars and walker walking training: used for initial walking training, suitable for patients with lower limb weakness but without paralysis, hemiplegia or amputation; for elderly people with slow movement or balance problems, walker can be used as a long-term walking aid. Specific operation method: a series of walking training can be completed in the parallel bar; the walking method with the walker is: hold the handrails on both sides of the walker with both hands, lift the walker so that it moves forward 20-30cm, then move the affected lower limb, then move the healthy lower limb to follow, and so on repeatedly.
(2) Double crutch walking training, including.
① alternate dragging step: extend the left abductor to the front, then extend the right abductor, and move forward to the abductor foot with both feet dragging at the same time.
② Simultaneous dragging step: both abductors are stretched out to the front at the same time, both feet dragging the ground to move to the vicinity of the abduction foot.
③swing to the step: both abductors are stretched out to the front at the same time, the patient’s body weight is shifted forward, the upper limbs are used to support the feet off the ground, the lower limbs swing at the same time, and the feet land near the abductor feet. This type of walking is suitable for patients who are completely paralyzed in both lower limbs and cannot move alternately. The movement speed is faster and the lumbar and hip force can be reduced.
④Swinging over step: Bilateral crutches are stretched out to the front at the same time, the patient supports the handles, shifts the body weight forward, uses the upper limb support to keep both feet off the ground, swings the lower limbs forward, and lands with both feet in front of the crutch landing place. When training, pay attention to prevent the knee from flexing and the trunk from falling by bending forward. Suitable for patients with complete paralysis of both lower limbs and strong upper limb muscles. It is the fastest way to move in crutch walking.
⑤ Four-point step: move only one point at a time when walking, keeping four points on the ground all the time, i.e. left crutch → right foot → right crutch → left foot, and so on repeatedly. It is suitable for people with bilateral lower limb dyskinesia who have good pelvic lift muscle strength and people or lower limb weakness. Is a good stability, safe and slow walking way.
(6) Two-point walking: one side of the crutches and the opposite foot are extended simultaneously as the first landing place, and then the other side of the crutches and the opposite other foot are extended forward again as the second landing place. This walking style is suitable for one side of the lower limb pain needs to reduce its weight with the help of crutches to reduce the pain stimulation; or practice after mastering four-point walking. It is close to the normal gait and the walking speed is faster.
(7) Three-point walk: the lower limb of the affected side and the double crutches are stretched out at the same time, the double crutches hit the ground first, and the healthy side is supported by three points before stepping forward. It is suitable for patients who have normal function of one lower limb and can bear weight, while the other side cannot bear weight, such as patients with fracture of one lower limb and paralysis of one lower limb after poliomyelitis. It is a fast moving and stable gait.
(3) Walking with a cane training, including
① Cane three-point walk: the patient uses the cane by first extending the cane, then stepping on the affected foot, and finally on the healthy foot. It is suitable for patients with lower limb movement disorders, and most hemiplegic patients are used to this gait. According to the basic condition of the patient, the exercises can be divided into posterior, parallel and anterior types according to the size of the gait of the healthy side foot.
Two-point walking with cane: The cane and the affected foot extend and support the weight at the same time, and then the healthy foot steps out. The cane and the affected foot are one point, and the healthy side foot is one point, alternately supporting the weight. This kind of walking speed is fast, so when the patient has a certain balance function or better mastered three-point walking, two-point walking training can be carried out.
③Wheelchair training: wheelchair selection and use techniques.
5.Caution
(1) Attention should be paid to the changes in the patient’s blood pressure during walking training.
(2) When walking training, provide a safe and barrier-free environment; the length of clothing should not reach the ground to prevent tripping; wear appropriate shoes and socks, laces must be firmly tied, should not practice walking barefoot, and strictly prevent falls.
(3) Choose appropriate walking aids and walking gait, choose a walking frame, crutches or cane of suitable height and length.
(4) If using crutches, avoid direct axillary pressure to prevent brachial plexus nerve injury.