Intensive Mobility Training

Intensive Mobility Training (IMT) is a form of physical therapy aimed at improving the gait, balance, and mobility of an individual by using task-specific motor skill training where there is little or no rest between sessions (“massed practice”.) Participants engage in several hours of therapy per day over multiple, consecutive days.  These back-to-back, condensed sessions have been shown to be effective for several neurological conditions including Parkinson’s disease, partial spinal cord injury, and hemispherectomy.

 

How is IMT Different From Traditional Therapy?

Traditional physical therapy protocols (also known as “distributed practice”) limit sessions to one hour or less per day with several days between sessions.  But current research shows that these sessions are typically insufficient to “rewire” an injured brain.[1]   IMT instead clusters the sessions together daily and back-to-back to maximize the intensity and frequency of the sessions.

Is IMT Effective For Children and Young Adults Post-Hemispherectomy?

Very little research exists which addresses reducing physical and other disabilities following hemispherectomy surgery.  In the only study addressing the effectiveness of IMT post-hemispherectomy, 19 children and young adults ranging in ages from five to 25 years old participated in an IMT program of three hours per day for ten days.[2]  Participants repeatedly performed activities such as body-weight supported treadmill walking, over-ground gait training, transitional movements, various dynamic and static balancing activities, proprioceptive activities, range of motion, strengthening, coordination tasks, and neuromuscular reeducation.   Participants were allowed no more than 30 minutes of rest each day over the ten-day period.

Results showed that children who were at least five years old at the time of the IMT program showed the greatest improvement in gait, balance, and mobility, without regard to underlying condition.  Additionally, as a group, children who had a hemispherectomy by the time they were five years old showed the most improvement.

Does IMT Work If A Child Has Limited or No Physical Therapy For Several Years?

In her current study – fully funded by The Brain Recovery Project and the first task in her role as Chief Science officer and Director of Research and Rehabilitation of that foundation –  Dr. de Bode examined whether a second dose of IMT would improve the gait, balance and mobility of several children who had received IMT in 2004. Using Dr. de Bode’s protocols, these children received three hours of IMT with only a minimal 10-minute break between each session over a ten-day period.

Functional magnetic resonance imaging (fMRI) provided courtesy of the Geffen School of Medicine at the University of California at Los Angeles, taken before and after the IMT program, revealed that the IMT sessions did in fact improve the gait, balance, and mobility of each child even though they had not had regular physical therapy sessions for several years.  One child, who used an ankle-foot orthotic on her affected leg prior to the IMT session, stopped using her orthotic permanently.  All parents of the children reported improvement in gait, balance and mobility, with some improvements seen as quickly as three days into the program.

 

Where Can I Find An IMT Program Near Me?

You can find a Lite Gait provider here and ask them to review the treatment paradigm below.

 

Where Can A Physical Therapist Learn About Post-Hemispherectomy IMT?

A treatment paradigm for intensive mobility training post-hemispherectomy can be found here.

In a partnership with Mobility Research ,  Dr.  Stella de Bode, Chief Science Officer and Dr. Nisha Pagan of Wholehearted Pediatric Physical Therapy, share their guidelines for IMT in this webinar.  1.5 CEUs available.

Research has found that the central nervous system is capable of changing and adapting even years post insult if an appropriate and intensive enough intervention is applied.