Progression | Treatment goal categories | ||||
---|---|---|---|---|---|
treatment phase (sessions) | Walking speed target | Symmetry target | Turning ability target | Gait adaptability/ translation to functional mobility | Intensity |
I (1–4) | Increasing walking speed in 10% increments, as tolerated, from baseline to the target threshold (either 0.4m/s or 0.8m/s depending on initial SSWS) | Improving symmetry of (a)step-length, (b) stance and swing phases in 10% increments, as tolerated |  |  | Four 5 min bouts of walking to total 20 min of stepping with each bout addressing one of the goals at a time |
II (5–10) | Increasing walking speed in 10% increments, as tolerated, from baseline to the target threshold (either 0.4m/s or 0.8m/s depending on initial SSWS) | Improving symmetry of step-length, stance and swing phases in 10% increments, as tolerated, while maintaining new walking speed | 10% improvement in turning towards ability to turn in two steps, 2 seconds in either direction while maintaining new walking speed | 10% improvement in the number of failures to hit targets presented unpredictably in timing and location on both limbs while maintaining new walking speed | Increase bout duration and decrease number of bouts; however, each goal is still addressed individually in blocks of practice |
III (11–16) | Practice at maintenance of walking speed over threshold and at altering speed as dictated by varying speed of presentation of footfall targets | Practice at maintenance of symmetrical stepping | Two steps, 2 seconds in either direction when turns are unpredictable | Able to alter stepping pattern to hit targets presented unpredictably in timing and location on either limb | 20–30 min of sustained *good quality stepping |