Home-Based Gait Aid Training Program

The intervention consisted of a home-based, carer-enhanced, and individually tailored training program for safe gait aid use, which was delivered over six weeks. All study physiotherapists attended a three-hour training course delivered by the chief investigator and received a manual on the assessment protocol and principles of motor skill training based on errorless learning [22 (link)] to help participants achieve implicit learning for gait aid use (see Supplementary Materials S6). Each study physiotherapist visited their participants at their home four times, scheduled at week 1, 2, 3, and 6, to provide training for safe gait aid use. Informal carers were required to be present to observe the training sessions and followed written instructions provided by the study physiotherapists at each home visit to supervise the practice of gait aid use with the participant; the carers were also required to enable frequent and constant practice in between these scheduled visits if considered safe by the study physiotherapists. Regular contacts between the chief investigative team and the study physiotherapists were maintained to ensure compliance with the designed protocol during the study.
The first home visit consisted of an initial assessment of the participant’s mobility and balance (as described above), a discussion with the participant and informal carer about their mobility requirements and preference of gait aid type, followed by a selection of the most suitable gait aid and adjustment of the gait aid to the participant’s height. All gait aids (either a 2- or 4-wheeled walker or a single-point stick) were purchased for the participants from a mobility equipment speciality supplier in Melbourne and Perth, Australia, and provided at no cost to the participants.
Different types of gait aids were recommended and provided by the study physiotherapists for the training program. Fifteen participants (62.5%) were provided with a 4-wheeled walker, six (25%) with a single point stick, two (8.3%) with both a 4-wheeled walker and a single-point stick, and one (4.2%) with a 2-wheeled walker. Twenty participants (83.3%) changed from not using a gait aid to walking with the provided gait aid. Four (16.7%) changed from using a less supportive gait aid to using a 4-wheeled walker (Table 1).
The training program allowed personalised variation as deemed appropriate by the study physiotherapists based on the mobility requirements (e.g., indoors, outdoors, step/kerb/stairs/ramp) and learning capacity of each participant. All visits typically consisted of approximately 30 min of training for safe gait aid use, focussing on the techniques of safe gait aid use and gait patterns for the participant’s mobility requirements.