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.  Turning away from a counter is a fall hazard because it is done by stepping backwards.  Feedback about how far away from vertical you have stepped is crucial.  Balance information from the inner ears is important when vision cannot help. After I fell and broke my forearm while turning I got scared.  I learned to turn by taking itsy bitsy baby steps before taking normal size steps in the new forward direction.

Research on this topic is emerging.  Chen trained stroke survivors on a straight OR a turning-based treadmill (1). Subjects walked on a round treadmill that turned underneath them as they walked in one place while holding onto parallel bars.  Subjects who learned to to accommodate the constant change created by the round treadmill were significantly better at turning while walking on level ground.  The example above shows turning has implications in the real world.  PTs and OTs need to address turning in their 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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