Re-training gait components for walking in the context of abulia

Abstract

A poor gait pattern is a common physical impairment following a severe brain injury. The goal of physiotherapy is to facilitate a return to normal movement patterns, which is usually achieved by interventions that emphasise re-acquisition of skills. However, this strategy may fail with individuals with concomitant cognitive and behavioural difficulties which compromise their potential to achieve optimal physical mobility. In particular, the loss of drive and alertness which characterises abulia presents a significant challenge to therapists. We report two single-case experimental interventions comprising multiple training strategies in which the focus of treatment design was alternatively on acquisition and maintenance of treatment gains. Training gait pattern in this manner resulted in significant improvements in walking ability and, in one case, continued high levels of performance during treatment withdrawal and at follow-up after 14 weeks. It is suggested that even patients with low levels of drive or initiation may be engaged more productively in therapy with the aid of interventions designed to promote systematic acquisition and maintenance of skills.