Page 6

C - Walking

Best Clinical Practices Best practices in walking rehabilitation are now underway in individual centres and could be implemented in multiple clinical sites. These practices are at the patient, program and rehabilitation practice levels, and need to be initiated in a formalized manner across Canada. Patient Level • Develop and employ methods to predict which patients have the most potential for walking recovery • Ensure each patient has access to a walking rehabilitation program on an outpatient basis • Align and strategically implement physical therapy interventions customized to specific patient goals, physiological, actual and potential capabilities. Program Level • Validate and implement standardized assessment tools for functional walking into clinical practice • Utilize walking programs for health benefits as part of clinical practice • Develop and participate in clinical trials designed to evaluate interventions to optimize walking capacity. Practice Level • Understand the meaningfulness of walking ability in the home, workplace and community for individuals with SCI • Analyze and track patient population walking outcomes at rehabilitation admission/discharge and longitudinally • Resource walking rehabilitation programs over the life course for fitness purposes. Key Clinical Issues: What is Needed for Best Practice? 1. Demonstrate and advocate for the value of clinical assessment paired with clinical decision making regarding therapeutic protocols. The accuracy of physical therapists’ ability to predict future mobility, at the time of rehabilitation admission, has been demonstrated to be extremely robust.5 This is important for patient goal setting, designing therapy protocols, discharge planning and equipment prescription; and for policy development for funding regarding outpatient locomotor training, given how important mobility is to long term outcomes. 2. Identify and determine the appropriate intensity, timing, duration, customization and type of walking interventions and programs. To date, studies have demonstrated that there is no superior method for gait training for individuals with SCI, thus making therapeutic intervention largely a clinical decision-making process, based on best evidence, for the varying combinations of therapies. Of import, intensity of therapy seems to optimize walking recovery. Understanding that biomechanical gait analysis can reveal information pertinent to the selection of a task-oriented approach to enhance gait training, as well as the therapeutic response that clinical evaluations alone cannot provide, is vital to customize interventions.6 Similarly, understanding the neurophysiologic findings from assessments, such as transmagnetic stimulation and imaging the spinal cord and the brain, may prove valuable for designing the metrics of therapy in the future. Unfortunately, walking rehabilitation programs are under threat as a result of cost-containment measures that have decreased the length of funded inpatient rehabilitation. This makes the development of outpatient rehabilitation walking programs paramount. 3. Optimize the integration of posture and walking capacity during recovery. Little is known about the integration of upright posture and walking, although individuals who demonstrate improved scores on the Berg Balance Scale are reported to have better walking function,7 making attention to postural training an important aspect of a walking rehabilitation program. 4. Monitor the longitudinal effects of walking capacity and how walking ability relates to body-structure and functions, secondary complications, participation in activities and quality of life. Monitoring longitudinal effects of walking capacity and the relationship to health status and wellbeing is another clinical issue. Although physical activity guidelines for SCI have been implemented across Canada, rehabilitation centres are not funded to provide walking programs as a means for maintaining fitness; and publicly-funded recreational venues do not have the adaptive equipment to support the SCI population. The clinical physical therapy community needs funding to develop walking programs for individuals with SCI, in outpatient clinics. WALKING | BODY STRUCTURE AND FNUCTION 51


C - Walking
To see the actual publication please follow the link above