Course curriculum

  • 1

    Application of HIT in the Clinic

    • Is there a goal for the total amount of time patients should be working at the target intensity per session?
    • How much time within a session should be focused on high intensity gait?
    • Some of the research to support elevating high intensity training used 20-to-30-minute sessions. How long is appropriate for high intensity training sessions? Is there a point of diminishing returns?
    • How long does a patient need to participate in HIT to make a lasting difference on their function? If they stop HIT after leaving inpatient rehab, is there regression of skill?
    • In patients undergoing rehabilitation within the first 6 months following a stroke, what type gains should I expect and in what time frame?
    • When you discuss total walking time in a session at a vigorous intensity, does that include warm up and cool down? Is it important to incorporate a cool down during HIGT?
    • How do we incorporate OT and assist with carryover to other disciplines? What should OT be focusing on?
    • During inpatient rehab, should gait training be split up between supported gait training in a harness on a treadmill and overground for assistive device training?
    • In higher level patients, does running/jogging on the treadmill have the same application to improving walking?
    • Do you measure patient steps in a session?
  • 2

    Biomechanical Subcomponents

    • At what point do you introduce obstacles or stair training?
    • Would you ever use ankle weights on a person who has adequate limb advancement for the sole purpose of increasing the intensity of the intervention?
    • When a patient is very impaired in most or all of the biomechanical subcomponents, how do you decide which one(s) to target first?
  • 3

    Cardiovascular Intensity

    • What are the differences between HR Reserve and % HR max? If a patient’s resting HR varies throughout the day, what do you use?
  • 4

    Safety

    • How often do you check vitals?
    • With COVID and patients having to wear masks in the facility, have you seen this change how they present during high intensity gait training?
    • The stairwell interventions: why not drill them in the II bars for safety?
    • Do you recommend stair training with patients who require maximum assist?
    • Do you frequently see patients pass out during training, especially early after injury?
  • 5

    Kinematics

    • If normal kinematics are associated with increased efficiency, why not incorporate kinematic training into high intensity gait training?
    • When do you decide on emphasizing more compensatory measures rather than maintaining a 100% focus on motor recovery?
    • Are there long-term studies on possible orthopedic issues resulting from abnormal kinematics such as knee hyperextension?
    • If a patient is having knee pain that may be related to abnormal gait patterns affecting the knee, is it then appropriate to address specific kinematics to try to address that pain?
    • What are strategies to decrease knee extensor thrust / hyperextension during stance?
    • What are strategies for patients with profound forward-flexed posture?
    • Are there any instances in which you find it appropriate to work on kinematics?
    • Are you providing any verbal cues for kinematics, like step length, knee extension, etc. or are you allowing the patients to figure it out without verbal coaching?
    • How many simultaneous cues are recommended for the biomechanical subcomponents?
    • Over what period of time should we expect to see a patient’s mechanics ‘normalize’ after participating in high intensity gait training / when can we tell if these gait deviations are more permanent?
    • Is it harder to change a patient’s ‘bad’ mechanics later in their recovery if they are permitted to ambulate with such deviations or variability early on?
  • 6

    Orthotics and Bracing

    • How do you decide when/whether/how to brace in order to maximize stepping and intensity of practice?
    • When do you choose FES vs AFO vs theraband to assist with limb clearance?
  • 7

    Spasticity

    • We’ve had some patients that demonstrate increased upper extremity spasticity while performing high-intensity training. Are there ways to avoid this?
    • How do you manage tone and spasticity? If spasticity is limiting your ability to meet the appropriate intensity, do you have any suggestions?
    • How do you accommodate for severe spasticity, thus poor ankle positioning that cannot be supported through bracing, when introducing high-intensity gait training? It feels unsafe to gait train with the ankle in such poor positioning due to tone.
  • 8

    Rest breaks

    • How often do you offer rest breaks during a HIT session?
    • How long should rest breaks be when warranted d/t form decomposition rather than RPE or HR being too high?
  • 9

    Patient Buy-In

    • What do you do if a patient isn’t up to walking on a scheduled day?
    • What is the #1 reason patients refuse HIGT?
  • 10

    Peer and Supervisor Buy-In

    • What are some tips for getting manager and clinician buy-in?
  • 11

    Application in Specific Clinical Populations

    • What if my patient has severe sensory impairment and/or inattention/neglect?
    • What if my patient has a tracheostomy?
    • Could you please suggest literature to review on HIT in CABG, valve replacement, etc?
  • 12

    Home Exercise Programs

    • What do you prescribe for a home exercise program during this training program?
    • To improve balance, I usually give patients a HEP in the corner i.e. a static balance HEP. Does this mean I really should be steering away from this because it's not as effective as a dynamic balance HEP?
    • In outpatient rehab, the HEP is so important. How do you give patients an effective error-based dynamic HEP without compromising safety?
    • How do you get patients to challenge themselves at home enough when they are only coming in 1-2x/week in an outpatient PT setting?
  • 13

    Clinical Prediction Rules

    • How are strength scores utilized in the subacute stroke CPR for HIT?
    • Is there a clinical prediction rule for stroke or SCI in the outpatient setting?
    • How might we use the subacute stroke CPR for HIT within our clinical practice?
    • Does age or type of stroke factor into the subacute stroke CPR for HIT?
    • In the subacute stroke CPR for HIT study, what was an average LOS for a patient with BBS = 5 and unable to ambulate without significant assistance?
  • 14

    Measurement

    • How well does the Berg Balance Scale predict falls in the inpatient rehabilitation setting?
    • Are both a self-selected and fast 10MWT recommended?
  • 15

    Entry-level education

    • What topics related to high-intensity gait training should be included in entry-level education? (2-3 hours of content)
  • 16

    Heart Rate Monitors

    • In using the Polar arm strap HR monitor and app, how do you maintain HIPAA compliance with patient info on the app?
    • Could you please provide some tips for documenting heart rate in the EMR?
    • How much are your heart rate monitors used on a weekly basis? For example, if you have have 20 monitors for 20 PTs, do you expect that each therapist would use the monitor daily?
    • Which heart rate monitor is best in terms of accuracy and ability to clean? How well do the earlobe monitors work? Can a wrist worn Fitbit work?
  • 17

    Equipment

    • What features should we look for in a weighted vest? Where can I buy one?