For many years, I have been presenting a small clinical staff meeting each month to future physiotherapists doing internships in our adult neurological rehabilitation department at the William Lennox Neurological Hospital Center.
The goal is to help interns better understand the origins of gait modifications observed in patients. For this, I use a simple, concrete, and always impactful demonstration.
I place a large marker between the toes of an intern, then I ask them to walk in front of the group, with only one constraint: not to leave any marker trace on the ground.
From the first step, a series of modifications appear in their gait (Situation A):
When I then ask the intern to correct the step length asymmetry, without changing the marker constraint, new compensations appear (Situation B):
What’s fascinating is that all interns adopt the same compensations, despite their physical differences or experience. These adjustments are natural adaptation strategies in response to an imposed constraint. They allow them to continue walking despite the obstacle.
It’s important to emphasize that our interns are in good health, both physically and cognitively. These compensations are therefore proof of a well-functioning brain, not the expression of a motor disorder.
And to improve their gait? There is only one solution: remove the marker.
This seems obvious. And yet, this logic also applies to our patients.
The gait observed in the intern is not pathological in itself. What’s abnormal is the situation in which they find themselves. The presence of the marker creates an artificial constraint. In other words, it’s a normal gait in an abnormal situation.
What’s the parallel with our hemiparetic patients? A patient with painful claw toes, for example, will adopt similar compensations. Their brain implements strategies to bypass pain or instability, exactly like our intern.
This demonstration therefore aims to sensitize future physiotherapists to two fundamental principles:
“You think your patients are full of flaws, when in reality, they are full of solutions.”
Personally, I find this very encouraging. Now it remains to identify the right causes… and act effectively.
Have you ever had the opportunity to witness this demonstration during a staff meeting?
How did you experience it? Has it helped you in your practice?
Try it yourself, and share your observations.
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