Page 34 - NAMAH-Jan-2023

Namah Vol. 30, Issue 4, 15th January 2023

to appropriate motor neurons that enable This assessment includes a ten metre walk to
movement. The CPG are capable of producing calculate current cadence (in steps/minute),
coordinated movement of the limbs with no velocity (in metres/minute) and stride length
input from the brain. Therefore, this magnet (in metres). Therapists should also evaluate
effect of auditory rhythm in synchronising gait kinematics, such as symmetry of gait,
and entraining movement patterns occurs muscle weakness, trunk rotation, arm swing,
even at levels below conscious perception posture, heel strike, toe off, single and double
and without cognitive learning. support time, and effective use of an assistive
device. In addition to the above-mentioned
Priming is the ability of an external auditory assessments in gait kinematics and stride
cue to stimulate recruitment of motor neurons length, several standardised gait assessments,
at the spinal cord level, thus resulting in such as the ‘Timed up and Go Test’ can be
entrainment of the muscle activation patterns in used to collect additional information related
the legs during walking. The concept of cueing to gait deviations.
of the movement period depends on rhythmic
entrainment and motor synchronisation In RAS gait training step 2 is all about adding
mechanism. When rhythm is used in cuing a rhythmic cue through a metronome/
with movement that means the time stability electronic tabla and music with a strong 2/4
is enhanced by rhythmic synchronisation metre walk, depending upon the tempo
throughout the whole duration and trajectory which is having the same cadence during
of the movement, and not just at the endpoints the client’s initial assessment. Metronome/
of the movements. A limit cycle is the step electronic tabla does not need to be audible
cadence or frequency in which a person’s to the client, but it should be audible to the
gait functions optimally. therapist to make sure that the rhythmic cue
is always driving the movement and that the
therapist who is not musically responding to
fluctuation in the patient’s speed. Initially,
the therapist may need to provide verbal
cues to help the patient to entrain, but they
should then fade their verbal cueing and
allow the rhythmic auditory stimulus to
drive the movement pattern. The therapist
should observe any immediate effects that
the rhythm may have on the gait kinematics,
What is RAS gait training? such as increased step-length, symmetry, or
changes in single and double support time.
This training consists of six steps and the In step 2, the therapist should include pre-
amount of time dedicated by the therapist gait exercises like a variety of movements,
in each and every step depends upon the stepping forward and backward, trunk rotation
level of functioning of the client. RAS training and arm swing exercises with dowels, heel-to-
session always begins with a thorough toe rocking, long arc quads, and leg abduction/
assessment of the client’s gait parameters. adduction.

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