Whole vs part method of learning to walk/run a new way: deviant to less deviant

The video above is a demonstration of using practice learning/practicing the parts and progressing to the whole.

The following is a detailed description and steps of the process or sequencing of cueing, coaching, and learning opportunities to walk/run a new way using the whole method and/or part method of learning/practice.

• First, provide verbal cues to alter the whole entire movement. If successful in step 1 practice the new way to walk/run
• If not successful in step 1 altering the whole movement of walk/run proceed to step 2 alter parts of the whole movement of walk/run using the “dance step to nowhere”. If successful practice dance step to nowhere proceed to “walk/run this way,” practice the whole movement of walk/run.
• If not successful in step 2 at altering the parts of the whole movement of walk/run using the dance step to nowhere proceed to step 3 to parts method learning/practice in standing alignment using manual cues and dance step to nowhere. When successful proceed to the whole movement of walk/run “walk/run this way.”

Step 1 uses the whole method of learning/practice

• Observe with traditional real-time clinical observation and/or 2D slow-motion video to Identify deviant movement.
• Show/share the deviant movement with the client.
• Is deviant movement on the right side of the body, the left side of the body, or both sides?
• Is deviant movement during the stance phase of gait, swing phase of gait, or both swing and stance phase of gait?
• Choose a reference limb either the symptomatic painful limb or the limb with the most deviant movement.
• Clinicians describe what is considered normal/not deviant movement.
  • Compared to less deviant limb
  • Compared to normative data
• Develop a working hypothesis. An if-then statement explaining the potential cause of deviant movement, or a rationale for potential chosen intervention. For example, if the client alters natural preferred relatively deviant walk/run and moves in a less deviant way, he/she will experience fewer symptoms, or no symptoms, avoid injury, and/or improve performance.
• Provide verbal cues and opportunities for the client to walk/run in a “new way.”
  • Verbal cue “don’t do that” or “can you figure out how to not move that way but move this way.”
  • Provide verbal cueing which is internal focused or external focused.
• Provide an opportunity to explore walk/run the “new way.”
• The clinician provides feedback on whether he/she is altering the deviant movement.
  • You are successful at walking/running the new way.
  • Dampen the effort to walk/run the new way - you overshot
  • Increase the effort to walk/run the new way - you undershot
  • You are not successful at moving new way, let's try step 2 learning to walk/run in parts instead of the whole
• Provide an opportunity to explore compare between moving “old way and new way.”
• Query the client.
  • What do you notice?
  • What do you feel?
  • Is there a difference in pain/discomfort?
• Next, if the original cue was internal focus provide an external focused
• Provide an opportunity for the client to move and compare between internal focused cue and external focused cue.
• Query the client do you have a preference between the internal focused cue and the external focused cue?
• Practice, repeat comparison between the old way and new way, always finish walking/running the new way.

If the client is successful in altering the movement deviation using the “whole method” of learning/practice proceed to “walk this way".

Step 2 progress to the part method of learning/practice

If clinician and client feel that learning to move the new way using the whole approach is not successful or not good enough, proceed to the “dance step nowhere”

• Request the client to step forward and back with the painful (P) leg in the swing phase. The nonpainful (NP) leg will be in the stance phase supporting all the body weight.
• Request the client to pay attention to and remember what he/she you see feels in the stance NP leg. The assumption is the movements in the NP stance leg are normal.
• Next step forward and back with NP leg in swing phase. The P leg is in the stance phase, the NP leg is in the swing phase. The assumption there is a greater amount of force occurring in the stance leg. Therefore, more likely to elicit pain and gait deviations.
• Request the client pay attention to and remember what they feel or notice in the stance leg, which is the P leg, not the NP leg that is swinging and moving.
• Query the client.
  • “What do you notice?”
  • “What do you feel?”
  • Is there a noticeable difference between what you notice occurring in the right leg compared to the left leg?
• Repeat this process several times to demonstrate reliability in the observations.

• The clinician describes what is considered normal/not deviant movement.
  • Compared to the less involved side
  • Compared to normative data
• Provide an opportunity for the client to move in a “new way.”
  • Verbal cue “don’t do that” or “can you figure out how to not move that way but move this way.”
  • Provide verbal cueing which is internal focused or external focused.
• The clinician provides feedback to client whether they were successful at altering the deviant movement.
  • You are successful at walking/running the new way.
  • Dampen the effort to walk/run the new way - you overshot
  • Increase the effort to walk/run the new way - you undershot
  • You are not successful at moving new way, let us try step 3 using the part method learning/practice in standing alignment
• Request client to compare moving the old way versus moving the new way.
  • Query the client.
    • What do you notice?
    • What do you feel?
    • Is there a difference in pain/discomfort?
  • Next, if original cue was internal focus provide an external focused
  • Provide an opportunity for the client to move and compare between internal focused cue and external focused cue.
  • Query the client do you have a preference between the internal focused cue and the external focused cue?
  • Progress from dance step to nowhere to “walk/run this way,” the new way. Return to step 1 use the whole method of learning/practice

If the client is successful in altering the walk/run deviation using the “part method” of learning/practice proceed to “walk this way”

Step 3 proceed to use the part method learning/practice in standing alignment

If clinician and client feel learning to move the new way using the part method is not successful or not good enough, the following is a deeper dive into the part method

• The clinician manually assists and verbally cues the client to align the stance phase limb in a more normal alignment/posture.
• Request the client to perform isometric contraction of appropriate muscles to stabilize and maintain the stance phase limb in the new alignment.
• The clinician touches the appropriate muscle cues the client this is the muscle that we need to engage.
• Request the client release the isometric contraction of muscles of the new alignment and allow the stance phase limb alignment to return to the natural or preferred alignment.
• Request the client actively move from natural preferred alignment to the new alignment by engaging the appropriate muscles
• Query the client
  • What do you notice?
  • Compared what you feel between the new alignment and old alignment?
  • What do you feel?
• The clinician manually assists the client to align limb in more normal alignment and posture, then requests the client hold the new alignment and “don’t let me move you” while the clinician attempts to perturb and disrupt the new alignment.
• Prompt the client to notice which muscles he/she is using to maintain the new alignment.
• Progress to request the client to move to new alignment and maintain the new alignment of the stance phase limb and to move the other limb in swing phase doing “dance step to nowhere”.
• The clinician provides feedback to the client whether he/she is maintaining the stance phase limb in the new alignment.
  • You are successful at maintaining the new alignment.
  • Dampen the effort to maintain the new alignment- you overshot
  • Increase the effort to maintain the new way - you undershot
• Allow client to explore maintain the new stance phase alignment during the dance step to nowhere. Establish a home practice schedule of dance step to nowhere.

After collaborating with the clinician in a supervised session the client can then choose to practice using the whole method, part method, alternate between whole and part method of learning/practice.

The information on this website is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to perform additional research regarding any information contained available through this website with other sources and consult with your physician.