# data[].attributes.headline
Ideas for obstacles and challenging environments

# data[].attributes.subject
Ideas for obstacles and challenging environments

# data[].attributes.body
Start parallel bars and step over obstacles, then change a.d.

Changing surfaces-complaint/noncomplaint

Different heights of boxes for stairs

Start stationary… move to outside (moving enviornment)

Teach different support strategies for falls

Obstacles courses (different directions).... Alter different foot clearnances…. Step

beach/sand

Do with someone else (like caregiver)

Transfers like bus/car

Walking while carrying

Different floor patterns

Escalator….

Mall!

Talking and walking!

Going over street...curbs….

Slopes,ramps

Tandem walking

Stepping over and around cones/hurdles

Walking on uneven surfaces

Walking/standing on foam

Using stairs/step ups

Walking on a treadmill while having to step over objects

Flip a coin that determines which direction you complete the obstacle course in

Wear different types of shoes

Use an agility ladder

Walk outside

Walk in the community with different distractions (i.e. other people, moving cars, etc.)

Walking in a pool

Walking at variable speeds

Walking while completing cognitive tasks

Walking while completing other motor tasks

Walking backwards

Walking sideways

Using incline treadmill

Using ramp to practice walking incline and decline

Walking from surface to surface (i.e. going from carpet to tile)

# data[].attributes.body
Visual cues for walking such as step length (tape on the floore)

Using zero G for progression

Walking comfortable speed and increase speed

Use verbal cues (walk slower, etc.)

Self competition….. Try and better it…. And compete between patients

Education & demo

Increase speed of body weight supported

Stretching and interventions for spastiicty

Bio feedback

Intrinsic motivation such as motivation and so on

Relay race

VR!

TreadMill

Practice in variable environments

Vision check

outcome measures for feedback (TUG, 6m walk test)

walk the dog

stretching/ROM

walking in water (adding ankle weights)

find out why they are slow

assess medications

Find out if issue is fear

community walking groups

assess use and appropriateness of/need for AD

balance training

music (walking to a beat)

walking around/over obstacles

check shoes/orthotics

posture (kyphosis) training

breathing exercises

Video pt walking for feedback and progress

possibly referrals

# data[].attributes.body
Stepping in place- march, arm up, march, arm up-- alternating

Weights around wrist

Patient walks in front of mirror

Elliptical/ New step

Tricep Extension Exercises

Alternating leg extensions and elbow drive

Standing band pulls with elbow straight and then elbow bent

PT pushes patient’s arm with poles to elicit arm swing-  neuromuscualar re-ed

Manually facilitate arm swing (hold hands while walking, dowels, ski poles

Use resistance band on back or front

Verbalize the correct arm/leg sequence (and then they verbalize)

Loftstrand crutches

Pelvic rotation

Objects to reach for

Gloves on parallel to reduce friction

Mirror training

virtual/augmented reality

PVC pipe arm swings

Exaggerated arm swing in place

Holding weights for proprioceptive feedback

Video tape for personal feedback

Push arms through water in pool

Have a target in front of them to reach each side or have object in front to grab with each step

# data[].attributes.body
Walking backwards-good to start with parallel bars

Strengthening extensor muscles

Stretching hip flexors because of forward lean

T spine manipulation

Core stabilization (TA - NOT rectus only)

Pec stretches

Postural exercises (chin tucks, scapular stabilizers)

Patient education on posture and balance

Visual training (don’t look at feet - choose a point on wall)

Pelvic tilt correction - muscle energy techniques

orthotics/bracing

Abdominal binder!

Theraband exercise- pull downs, rows

Lat stretch

Multifidi strengthening in quadruped

I, T, Y, W on ball or prone on mat

On theraball- straighten one leg at a time

Pelvic clocks on theraball

Pd. education on ergonomics

Tall kneeling exercises

Hamstring stretching

Supermans

Assistive devices- correct height

Manual PRN

Balance training

Visual training- mirror

Wall squats with ball behind back

Stabilizing reversals in bridging - resisted bridging A-P, then M-L, then all directions

T-spine extension/ opening exercises (scapular wall slides, book openings, mat angels, brueggers)

Holding candy cane behind back - sitting, kneeling, then standing

Walking and reading poster on wall to promote upright head posture

Bracing/ k-taping

Sitting on stability disc then stability ball

Seated star extensions on mat, stability disc, then ball

Seated on stability ball then weight shifting from left to right

Seated on stability ball with marching and alternating UE movements

Anything in tall kneeling is good

LSVT BIG and LOUD (especially for Parkinson’s patients)

Posterior chain exercises
scapular retraction

OH reaching activities

Pec stretching (get shoulders back)

improving hip flexors strengthening and stretching

general core strengthening

cervical retraction/chin tucks

video/pictures to give them feedback

thoracic manipulations

activity modifications (improve work station for example)

patient ed on how improved posture will benefit their treatment

# data[].attributes.body
breakdown beginning stages to initial contact and push off

toe and heel raises

rocking back and forth

treadmill walking

Resistance training for push off

Walking with ankle wegihts

Walking in water

Stair climbing

Stair descending

Obstacle courses

Exo skeleton

Cycling

Over exaggerated stepping (BIG)

Alternate toe and heel walking

Treadmill pushes (it’s off, make the belt off)

Incline walking

marching

Heel raises

Verbal cueing for heel to toe initial contact and arm swing

Bungee resistance training

Video analysis and visual feedback

DF flexibility

Hip extension (trail limb) flexibility

LE strengthening

Trunk flexibility

Balance training

Assisted device

Background music for timing and motivation

# data[].attributes.headline
Ideas to improve foot placement & clearance

# data[].attributes.subject
Ideas to improve foot placement & clearance

# data[].attributes.body
Orthotics

K-tape

NMES

Gait training

Begin with practicing normal gait pattern - heel-to-toe pattern while walking on the treadmill either with verbal cues or manual contact from therapist.

Step overs using cones at specified distances.

Practice forward steps (heel-toe), side steps (making sure the toe remains facing forward) and backwards with toe-heel contact.

Using a grid practice on increasing step length or step width.

Practice marching, first in place, then with stick and walking, then over hurdles, and then without stick for support. Practice marching with music to work on rhythm of gait and steps.

Place foot markers on the ground and have the patient practice walking with even steps

Place tape over the floor in a straight line and have patient practice walking straight along the tape, or along a balance beam, to improve balance.

Practice altering the patient’s BOS (wide, narrow, tandem).

FES

Step ups: lateral, forward, and backward first on a low step and then on a step approximating normal height to work on foot clearance. Then do it on compliant surfaces.

BWS treadmill training

Muscle strengthening

dorsiflexors - 4 way cankle

Knee flexors - hamstring curls, hip hinging, prone SLR

Hip flexors - SLR, TKE

Hip abductors - sidelying SLR, standing hip abduction

Muscle stretching

Hip extensors - hamstring stretch strap or four-way with leg elevation/table stretch

Plantarflexors - slant board

Orthotics

agility : ladder, stepping over cones, hurdles

balance: tilt board, BAPS board, airex foam (alter their BOS);  make it harder with perturbations, eyes closed

Strengthening: hamstring, quads, dorsiflexors

Dots on the floor: have them try and go back and forth with stepping

SLS and glut med strengthening

4 way ankle ROM with T band

Standing marching

Verbal cueing

Stepping over canes

4 way lunges

Tape targets for steps

Straddle tape line

Obstacle course

LSVT (big and loud)

Tactile cueing

Good shoes

Rolling walker to help make patient upright

AFO

Ace wrap ankle

FES

Education to remove trip/fall hazards

PNF patterns

Gait training with mirror

Stepping over hurdles

Agility ladder

Theraband placed around foot to help with foot clearance

Work on DF strengthening

Orthotics

Place squares on the floor

Hip hikes to prevent pelvic drop

Cone taps & color taps

Video of walking

Put a barrier between the foot or knees

Gait training in the water

Education on what the foot placement is supposed to be & positioning of the foot

Dance revolution

Walking through an obstacle course

Put tape down and they have to stop on the tape (at the perfect width & step length)

Single leg balance training

Strength training

Walking in front of a mirror

Biofeedback of movement

Calf stretching