Exercise programs to improve gait performance in people with lower limb amputation

Wong, Chi Song; Ehrlich, Julie E.; Ersing, Jennifer C; Maroldi, Nicholas J.; Stevenson, Catharine E; Varca, Matthew J

doi:10.1177/0309364614546926

Cited by 62 publications

(51 citation statements)

References 26 publications

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“…This search revealed limited literature on the subject, which is consistent with a recently published systematic review that identified eight studies investigating the effectiveness of exercise programs to improve gait performance in lower limb amputees (37). The difference in the number of studies may be due to the other review (37) limiting included articles to one-group cohort, pre- to post-test studies, two-group case-control trials, and control trials, whereas this review included all publications, including expert opinions. Though publications are limited, our literature review supported our hypothesis that multiple gait training modalities are effective to improve overall gait quality in lower limb amputees.…”

Section: Discussionsupporting

confidence: 79%

“…Ephraim et al reported that approximately 63% and 49% of amputees experienced back pain or pain of their intact limb, respectively (48). Also, reduced self-selected walking can make participation in functional and recreational activities difficult and lead to reduced safety when ambulating in the community, such as being able to cross the street in an appropriate amount of time (37). This reinforces the importance of reducing spatiotemporal gait impairments to improve functional mobility, increase safety, and increase amputees' ability to participate in their typical functional and recreational activities.…”

Section: Discussionmentioning

confidence: 99%

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Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

Millman

et al. 2016

technol innov

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Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

Millman

et al. 2016

technol innov

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“…Whereas individual clinicians may use manual therapy on a case-by-case basis, 17,48 typical treatment emphasizes functional training without specifically addressing underlying joint impairments that contribute to functional deficits. 7 In this study, gait and balance performance improved after all subjects received four treatment sessions that included hip, sacrum, and sacroiliac joint mobilizations-with no adverse events occurring. Subjects also performed exercise, balance, and gait training as in a variety of past rehabilitation programs, 7 but the effect size changes observed after the study program including manual therapy were larger than in past studies except for those that lasted more than twice as long.…”

Section: Discussionmentioning

confidence: 63%

“…7 Although no best practice consensus approach was determined, rehabilitation programs ranging from specific exercises, balance training, resisted gait training, and indoor and outdoor functional walking have been shown to improve gait performance as assessed by gait speed. 7 For instance, a program limited to training balance, the most consistent impairment affecting gait in people with lower-limb amputations, 3 has improved both balance and gait speed, 8 and a program of only supervised walking has also benefited functional walking. 9 Because gait speed is the product of cadence and step length, any factors that influence either will influence gait performance.…”

mentioning

confidence: 99%

Impact of a Four-Session Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and Prosthetic Walking Ability of People with Lower-Limb Amputation: A Pilot Study

et al. 2016

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Purpose: No consensus exists regarding best practice for prosthetic rehabilitation programs after unilateral lower-limb amputation. A program integrating manual therapy with exercise for people using lower-limb prostheses has not been systematically investigated. The objectives of this pilot study were to determine whether a four-session physical therapy program of manual therapy, exercise, and functional training would (1) be feasible for people with lower-limb amputation and (2) produce medium to large effect size changes in balance and walking ability and self-reported prosthetic function. Methods: Five subjects were recruited for this pretest-posttest design pilot study. Outcome measures included self-report scales (Houghton Scale, Prosthetics Evaluation Questionnaire, fear of falling, and Activities-Specific Balance Confidence) and clinical performance assessments: Berg Balance Scale, 2-minute walk test, and timed up and go test. One week after the four-session manual therapy, exercise, and functional training program concluded, measures were reassessed. Effect size d and Wilcoxon P values were calculated. Results: Five subjects (average age, 54.0 years), with unilateral amputations of mixed etiology and level, completed the study without adverse event. Berg Balance Scale (d = 1.7, p < 0.05), timed up and go (d = 1.05, p > 0.05), and 2-minute walk test (d = 1.18, p < 0.05) had large effect size changes. Conclusions: A four-session program of manual therapy, exercise, and functional training proved feasible and increased balance and walking ability in people with lower-limb amputation. Controlled research to determine the effects of manual therapy and exercise in this population appears warranted. (J Prosthet Orthot. 2016;28:95-100.) KEY INDEXING TERMS:Berg balance scale, exercise, functional mobility, gait, limb loss, lower-limb, manual therapies, prosthesis, 2-minute walk test T he prevalence of people with amputations is expected to more than double to 3.6 million by 2050, with 40% having had major lower-limb loss. 1 After lower-limb amputation, a multitude of individual and clinical factors can impact community mobility and participation outcomes among users of prostheses. 2 In a review of 48 studies, balance impairment was identified as the most consistent clinical finding associated with decreased prosthetic function. 3 Gait dysfunction persists, with approximately half not achieving a satisfactory level of prosthetic use even after multiple years. 4,5 As hospital lengths of stay have decreased for individuals after amputations, 6 more prosthetic gait training occurs in outpatient settings. A recent systematic review found that few detailed outpatient rehabilitation programs for users of lower-limb prostheses have been researched. 7 Although no best practice consensus approach was determined, rehabilitation programs ranging from specific exercises, balance training, resisted gait training, and indoor and outdoor functional walking have been shown to improve gait performance as assessed by gait speed. 7 ...

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“…In addition, the treatment performed after amputation was extremely also important, the use of cryotherapy, laser, bandaging and desensitization of the stump, necessary for rehabilitation and prevention of deformities, and the maintenance of skeletal muscle functions altered [18][19][20][21]. During the rehabilitation period the goal of physical therapy is muscle strengthening, balance exercises, gait training, and functional training programs demonstrated small to large effect size gait performance improvements in people with lower limb amputation [22,23]. These objectives were found at the end of the treatment of this patient with analysis performed in this case study.…”

Section: Discussionmentioning

confidence: 99%

Physical Therapy in the Pre and Post the Transtibial Amputation

Dorta¹

2015

Int J Phys Med Rehabil

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Patient, 62, male, suffered a fall in his residence and suffered a distal 1/3 intra-articular tibia fractures (type of tibial pilon fracture, Grade III), held a surgery for bone reconstruction with the need to use metallic synthesis, later came to develop osteomyelitis, achieve chronic and severe stage. He don`t responded to antibiotics, it was decided to perform the amputation member. From the time when the first operation after fracture and to make the second transtibial amputation, intense physical therapy for 06 weeks was carried out, with positive results in a short period of time, it appears that the treatment of pre amputation accelerates the process of prosthesis, gait, balance and therefore the return of their activities of daily living.

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Exercise programs to improve gait performance in people with lower limb amputation

Cited by 62 publications

References 26 publications

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

Impact of a Four-Session Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and Prosthetic Walking Ability of People with Lower-Limb Amputation: A Pilot Study

Physical Therapy in the Pre and Post the Transtibial Amputation

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