Appraisal of treadmill training in gait rehabilitation in patients with neurological disorder and their attainment of community ambulationIntroductionWalking difficulties is one of the main features of neurological disease and loss of mobility is the main activity of daily living which is most valued by such patients (Lord and Rochester, 2005). Different neurological pathologies and impairments often result in abnormal or reduced walking. Multiple sclerosis (MS) is an example of neurological disorder where an individual presents with weaknesses and spasticity from pyramidal tract lesions, vestibular and visual dysfunction, pain and cognitive and mood disturbances which may all contribute to difficulties in walking (Brown, Bradberry, Howze, Hickman, Ray, and Peel, 2010).
In this case mobility is determined by weaknesses in primary muscle disease although secondary factors such as contractures, weight gain, breathlessness and fatigue may have major impacts on the mobility of the patient (Ada, Dean, Lindley and Lloyd, 2009). In such cases the degree of impairment is not linearly related to the activity and participation. For instance the walking speed is poor correlated to leg strength while various environmental factors and personal factors may influence the impact of similar degrees of loss of walking on mobility.
In neurological disorders such as MS, impaired walking could be an indication of both progression of disease and disability (Mayr et al. 2007). The regaining of walking in patients with neurological disorders such as Parkinson’s disease (PD) and MS is a vital outcome measure in their treatment. It has been argued that mobility measurement could have a direct influence on the accessibility to treatment in such disorders (Lord, McPherson, Rochester and Weatherall, 2008). This is exemplified in treatment of MS where maximum walking distance determines whether a patient is eligible to take disease modifying drugs or not (Ada et al.
2009). Gait is regularly observed by clinicians for diagnostic purposes and forming opinions on patients with neurological disorders (Lord and Rochester, 2005). This is usually aided by the patient’s impression as to the effect of walking in the context of disease progression or response to treatment (Herman et al. 2007). Walking is often measured objectively in case of monitoring the state of neurological disorder (Koenig, Omlin, Zimmerli, Sapa, Krewer, Bolliger, Muller, and Riener, 2011). Community ambulationCommunity ambulation is outdoor locomotion that entails activities which are essential for living independently (Miller, Quinn, and Seddon, 2002).
This may include activities such as visiting the bank, supermarkets and pharmacy (Brown et al. 2010). It is the ability of an individual to integrate walking with other activities in a complex environment (Ada et al. 2009). Patients recovering from neurological disorders such as stroke need to have better community ambulation in order for them to be able to enjoy quality life after leaving hospital premises (Banala, 2008).
The ability of such patients to regain independent community ambulation is integral to quality of life for such recovering patients and their ability to reintegrate in the society. The International Classification of Functioning, Disability and Health (ICF) provides a description of the existing interaction between physical, social and environmental factors with the health conditions of an individual which produce outcomes which are of interest to the physical therapists. According to ICF activity is the execution of an action or a task by a person which mainly focuses on his rehabilitation efforts (Lord and Rochester, 2005).
Therapists are involved in improving the endurance, increasing gait speed and improving an unsteady gait or a person’s poor ability to climb stairs. All these activities are essential for maintaining independence. ICF also encourages participation which encourages individuals to be involved in a social situation (Koenig et al. 2011). Participation has been identified as an essential domain of function which is integral to quality of life led by an individual (Brown et al. 2010). The participation of an individual in society is dependent on the environment in which the individual is found according to ICF (Hallett and Poewe, 2008).
ICF argues that the mobility of an individual in a community may be strongly influenced by the environment and that the physical requirements may not be constrained to variables which are associated with terrain, speed and distance (Ada et al. 2009). Thus ICF is related to community ambulation since it enables the patient to integrate into the society and perform various tasks independently.