6
- Prosthetic cause: prosthesis is too short, foot is too far outset, ineffective lateral socket containment, medial wall too high
- Patient cause: inadequate balance, abduction contracture, weak hip abductors, pain
Lateral trunk lean
- The patient must be able to balance on prosthetic limb long enough to bring other limb forward in a controlled manner
- Weight shifting
- Single leg stance
Prosthetic control
- Prosthetic cause: device is too long
- Patient cause: lack of confidence in flexing knee, abduction contracture, weak hip flexors, habit
Circumduction
- Early ambulation with a walking aid
- In shoe auditory feedback devices
- external cues: verbal, tactile
- Psychological awareness training
Spatiotemporal gait parameters
- Improved bioenergetic efficiency compared to overground walking -- BUT low quality evidence
- Improvements found: 6 min walk test distance, gait speed -- TUG, increased treadmill speed, improved spatiotemporal parameters for lower limb amputees
- NO significant differences found between treadmill with and without body weight support
- Frequency and duration recommendations
Treadmill training
- Prosthetic cause: device is too long, medial trim line is too high
- Patient cause: abduction contracture, weak hip, patient is insecure and not wanting to put weight through device
Abduction
- Prosthetic cause: prosthetic foot is too far outset, excessive socket adduction
- Patient cause: insecurity with balance/gait, weak coronal plane knee control
Wide based gait
- Prosthetic cause: unstable prosthetic knee, excess socket flexion, excess ankle DF, poor suspension, short toe lever, residual limb pain
- Patient cause: insecurity with weight acceptance, weak hip flexors, poor balance
Asymmetrical step length
- Usually in parallel bars
- Balance and weight shifting
- salsa step
- Key: spend time in balance and pre-gait activities before moving ahead or patient may develop a less desirable gait pattern
Pre-gait
Gait deviations observed when patient is walking will become more apparent when patient increases his/her cadence and runs
Gait progression
- Sideways for steep inclines leading with sound limb
- Step to pattern, small step lengths
- Reciprocal for small grades
Ascending ramps
- Step to pattern -- classic rule applies
- Reciprocal pattern: K3 and above; depends on prosthetic componentry
- Hands, foot, and pelvis should be in line, If hips are posterior, then knee will buckle
Stairs
- Sideways for steep declines leading with prosthesis
- Step to pattern, small step lengths
- Error augmentation gait training
- After training: persons with transtibial amputation demonstrated ability to adapt; short term after effects in step length symmetry
- Clinical application: patients with limb difference may develop greater flexibility of locomotor strategies to changing environments if interventions that promote adaptability are used during rehab
Split belt treadmill training
- Comprehensive HEP
- Aerobic ex; strength training; balance exercises; flexibility exercises
- Community resources/support groups
- Caregiver resources