Table 1.

Movement strategy training protocol

Principles of Movement Strategy Training [13,33,34,44]

• Use visual, auditory or somatosensory cues to optimise timing and amplitude of actions, movements and their components

• Use attentional strategies such as focussing on key movement components, visualising correct amplitude or pattern, mental rehearsal, visualisation

• Break down complex movements into parts and focus on each segment in sequence

• Practise individual components of activities separately before incorporating into whole

• Incorporate cues and attentional strategies into functional tasks with reference to home environment.

• Individualise strategies, repetitions, and environmental context, with consideration to level of disability and functional difficulties

• For people with mild levels of impairment, consider practising dual tasking to promote motor learning. For those with advanced disease, avoid dual tasks

Activities

Walking

Walking with visual cues or attention strategies to correct step size to criterion length. Incorporate stopping and starting, with auditory cues if gait initiation difficulties.

Turning

Walking while turning, in either 'arc' or 'clock' (on the spot) patterns. Cues may include tape on floor, cue cards, photos, with attention to step size and placement.

Practise different turn magnitudes and turn activities relevant to home and community environment.

Reaching in Standing

Practice varied reaching activities in functional contexts, progressing to reach for objects of different weights and sizes at differing heights. Emphasise conscious attention to postural stability and position prior to reach.

Sit to stand

Modify chair height to assist or challenge patient, practise from different styles of chairs, chair height and compliances of chair and floor surface. Emphasise conscious attention to movement sequence in conjunction with amplitude, speed and flow of movement. Use visual cues such as photos or cue cards with key words.

Transfer from chair to chair

Practice transferring from chair to chair with the seats in different configurations, including at tables and in theatre rows. Encourage conscious attention to movement components in sequence and ensure safety. Visual and auditory cues may include cue cards with key words or pictures.

Getting up from bed

Emphasise normal timing and maintain momentum. Practise from same side of bed as person uses at home. Use assistive devices such as a bedpole where appropriate. Attentional strategies should focus on position in bed, sequence and speed and flow of movement. Cues could include cards with key words, photos or pictures.

Protective stepping in standing

Practise taking quick, large steps in different directions. Practise responding quickly to a verbal cue to step, or to a tug or push in a known or unknown direction. Encourage attentional strategies, such as focussing on visualising big and fast steps in the direction of loss of balance.

Complex walking tasks

Practice dual or multi-tasks, and obstacle course negotiation. Encourage mental preparation or movement visualisation, with pre-planning of the obstacle course and recognition of potentially difficult areas.