Table 3 Locomotor Training Progression
Phase and Sessions | Training Priorities on the Treadmill | Treadmill (TM) Speed | Body-Weight Support | Intensity/Endurance | Manual Assistance | Overground/Community Ambulation |
|---|---|---|---|---|---|---|
Phase I (1–12) | 1. Intensity 2. Speed 3. Independence at non-paretic leg | 1.6 mph minimum (goal of 2.0 mph) | 30 – 40% | Four 5-minutes bouts to attain 20 mins of stepping | As needed at trunk, paretic and nonparetic leg. Decrease assist at non-paretic leg. | 1. Attempt skills observed/trained on the treadmill 2. Educate on use beyond clinic |
Phase II (13–24) | 1. Intensity at 2.0 mph and decrease BWS 2. Progress independence at trunk/pelvis with short bouts (decrease speed, increase BWS as needed) | 2.0 – 2.8 mph | 20% – 35% | Increase bout duration with decrease in number of bouts to attain 20 mins of stepping | Decrease assist to first trunk/pelvis, then paretic leg | 1. Attempt skills observed/trained on the treadmill 2. Transfer skills/speed 3. Introduce assistive device and orthosis, as needed |
Phase III (25–36) | 1. Intensity to 30 mins 2. Progress independence with increased bout length, then increase speed, decrease BWS. 3. Adaptability (speed variations, stop/starts, incline) | 2.0 – 2.8 mph and increasing speeds | 0 – 20% | Increase total stepping time to 30 mins | Removed | 1. Transfer skills/speed 2. Adaptability to environment: stairs, curbs, terrain and change speed, stops, turns. |