Facilitating the Components of Gait, 2 parts.

This two-videotape collection was created to sharpen the viewer's observational and treatment skills in facilitating independent gait in children with developmental disabilities. The emphasis in both tapes is to analyze the building blocks or components of gait necessary for independence. Examples of treatment strategies are then illustrated. Four case studies, all of children with motor handicaps, are used for observational analysis and treatment.

Part 1 consists of a discussion of the components of gait, emphasizing the hip, pelvis, and trunk. Examples of components of gait emphasized throughout the video are muscle strength, range of motion, joint alignment, weight shift, balance control, motor planning, spatial awareness, and right-left dissociation. The discussion, though not at all biomechanical, is the basis for the case studies to follow. Examples on an asymptomatic adult are shown to illustrate various pelvic tilts and trunk rotations in sitting, quadrupedal. and standing postures. A brief overview of immature gait in an asymptomatic toddler is also included. The pace of this introduction is quick but organized and merits reexamination to the viewer's satisfaction in order to follow the case studies.

Two case studies are reviewed in part 1. The first presents a child with spastic quadriparesis, and the second presents a child with ataxia. in both cases, a narrated developmental history precedes an observational analysis of gait pattern with and without ambulation aids. Treatment emphasizes handling, stretching, and muscle stimulation techniques (deep friction massage and vibration). Therapeutic handling is demonstrated in postures such as sitting, standing, quadrupedal, and plantigrade and in transitional postures such as sitting to standing, half-kneeling to standing, or quadrupedal to half-kneeling. Finally, walking is encouraged with facilitation by the therapist. Suggestions for carryover in the home are also shown.

In both of these case studies, the viewer is introduced to Ms Hypes' vocabulary and methods of observation. She often talks about "softening of muscle" after tactile facilitation, or "collapsing into the base of support" when the child is losing balance or falling. She also emphasizes higher dynamic postural control against gravity, pelvic-femoral or pelvic-spinal mobility and stability as appropriate, and coactivation of hips and trunk.

Part 2 follows the same case-study format. Two children, both with severe cognitive impairments along with poor sensorimotor control, are observed. Because the same principles of observation and treatment are exemplified in part 2 as in part 1, the narrative and handling become easier to follow. The second case study on this videotape shows co-treatment with an occupational therapist. Both children are shown using knee-extension splints and standing frames for facilitation of motor control.

This two-part series sharpens the viewer's skill in observational analysis of gait. The handling techniques and the methods of facilitating movement and postural patterns are repeated and modified for each child. The viewer retains the principles of encouraging functional gait with this consistent presentation. The viewer can quite easily watch portions of the videotapes over and over to grasp different concepts and treatment suggestions. These videotapes are excellent training tools for physical therapists, physical therapist assistants, and students interested in encouraging walking skills in individuals who are developmentally disabled.

Diana N Goldstein, PT Pediatric Physical Therapy Bow, NH

Ms Goldstein works in several school systems and in an early intervention program located within central New Hampshire. She has been a regular reviewer for Physical Therapy on topics related to pediatrics, motor development, and motor learning.