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Diagonal Stepping – Peripheral Strengthening

Motor learning, calibration, and functional ambulation

Documentation and Activity Rationale

The patient engaged in a multi-modal diagonal ambulation pattern around cones placed 14-18″ apart while maintaining balance between transitions, stability during mobility, and postural alignment in rhythmic coordination to a metronome at 56-75bpm. The patient was required to sustain a cylindrical grasp while holding a small 3lb ball with bilateral hands over the course of the activity. This task is purposed to elicit and improve agility, movement absorption, eye-foot coordination, gross mm activation of fine and gross mm, visual spatial awareness, gross Strengthening, improved postural alignment during functional ambulation, and dynamic standing balance during one foot transitions resulting in greater perceived confidence in ability to be independent and increased self-sufficiency in ADLs and IADLs requiring the aforementioned performance skills. The patient stated he has experienced success with these activities at home where he has attempted them “once or twice”. The patient demonstrated hesitancy at first, but increased in dynamic mobility and confidence by the end of the activity which was broken up into two parts with rest breaks offered intermittently. Each set required clearance of appx 9 cones over 20ft and consisted of appx 4-6 sets. The patient reports this is a good challenge.

Grading Strategies

Grading Up:

  • Use ankle or wrist weights
  • Increase weight or mass of object being held
  • Increase pace 
  • Widen the space between cones
  • Incorporate dual tasking component

Grading Down: 

  • Lessen or remove object being held
  • Lessen the space between cones
  • Offer more rest breaks

Appropriate Diagnoses / Deficits

  • Generalized Weakness 
  • SCI
  • CVA
  • TBI
  • Balance deficits