Re-educating Functional Walking

Abstract

“The ability to walk upright on two legs has played a key role in human life-style for more than 3 million years” (Sagan 1979). The ability has broadened our lives and enabled us to acquire countless skills which would otherwise not have been possible.” “Human gait is the most common of all human movements. It is one of the most complex totally integrated movements and yet is probably the most taken-for-granted. But walking does not come automatically like breathing. It must be learned” (Winter 1988). Because of our relatively small base in the upright posture, we require highly complex reactions to maintain our balance when walking. These balance reactions are dependent upon postural tone and the capacity to perform selective movements as described in Chaps. 2 and 3. Based on the results of animal experiments, it has been postulated that the basic movement synergies of locomotion are produced at spinal levels by so-called central pattern generators (CPGs) (Brooks 1986; Grillner 1981; Smith 1980) However, such spinal generating circuits, when stimulated by tonic activity, “produce, at best, a bad caricature of walking due to the lack of important modulating influences from the brain-stem and cerebellum” (Shumway-Cook and Woollacott 1995). In reality, as is the case with human movements in general, the movements required for functional walking arise from the interaction of multiple processes, including both perceptual and motor, as well as from the interaction between the individual, the task and the environment. “In respect to legged locomotion, the level of synergies can generate the intra- and inter- Limb patterns but not actual, functional locomotion, which requires continuous and meaningful adjustments in anticipation of upcoming circumstances,” and “the level of synergies’ facility in guaranteeing the internal coherency of a movement contrasts with its inability to adjust the complex and harmonious movements which it produces to changes in the environment” (Turvey and Carello 1996). In real life, the movements involved in walking are dictated by plans, intentions, the wish to perform a task or solve a problem, and of course the necessity of adapting to the environment and the objects within it. Within each step cycle, the movements are finely tuned according to the needs of the task (Grillner and Zangger 1979). Because human locomotion is essentially so complex and dependent upon many higher centres, the re-education of walking entails far more than merely stimulating activity in the lower limbs or strengthening relevant muscles. It is easy to understand why some patients may require long and intensive treatment before learning to walk again and why many others who, although able to get on their feet again quite soon, will need skilled therapy to improve the way in which they walk Regardless of the problems, the time and the effort required to ensure the best possible result should not be restricted.