April 16, 2016

Teach Us to Turn in the Kitchen

Walking in straight lines in the PT gym and walking around the block at home did not prepare me for the problem solving I need do while walking.  After I got home from rehab I had to teach myself to safely turn 180 degrees after shutting the bathroom door and again when flushing the toilet.  

Here is another example.  The photo shows the turns I take to prepare a glass of iced tea and a bowl of cereal with a sliced banana for breakfast.  After I fell and broke my forearm while turning I got scared.  I learned to take itsy bitsy baby steps until I complete a turn before taking normal size steps in the new forward direction. 

Help is emerging.  Chen trained stroke survivors on a straight OR a turning-based treadmill (1). Clients on a round treadmill held onto parallel bars while they walked in one place as the treadmill turned underneath them.  Subjects who trained on the turning-based treadmill were significantly better at turning.  Turning away from a counter is done by stepping backwards as you turn so feedback about how far away from vertical you have stepped is crucial.  Balance information from the inner ears is important when vision cannot help.  Paradoxically, the turning-based treadmill group also walked significantly faster in a straight line.  Perhaps walking on the turning treadmill forced clients to be more vigilant about where to place each foot so walking in a straight line was easy by comparison.  PTs and OTs need to incorporate these findings into clinical practice.  

1. Chen, I, Yang, Y, Chan, R, Wang, R. Turning-based treadmill training improves turning
    performance and gait symmetry after stroke. Neurorehabilitation and Neural Repair. 2014;28

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