AIM:
To improve walking using manual guidance via a stick.
Rationale:
People with ataxia demonstrate dyssynergia, ie, loss of smoothness of movement due to joints being moved independently or at abnormal rates to each other. Practice is set up so that the patient is encouraged to sustain force production during walking.
This exercise aims to improve the smoothness of walking.
Equipment:
- Walking stick
Key Points:
- Patient holds the stick horizontally in front with the shoulders flexed to 90o and elbows fully extended
- Therapist applies horizontal pressure through the stick to encourage sustained force production
- The pressure should be maintained throughout walking
- Patient must not pull on the stick and must keep the elbows straight
- Therapist must move each leg backwards in synchrony with the patient’s steps
Common Errors:
- Patient flexes at the hips (if this occurs, the therapist should hold the stick slightly higher)
- Therapist provides too little/too much pressure
- Therapist blocks movement
- Therapist’s steps are not timed with patient’s steps
Progression and Variety:
- Backwards walking using manual guidance via a stick
- Increase speed
- Patient practices without manual guidance