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

Abstract

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.

Benefits of the Genium microprocessor controlled prosthetic knee on ambulation, mobility, activities of daily living and quality of life: a systematic literature review

“…Items were classified as not applicable to the design of prosthetic studies in some cases. Publications were classified as having "high" validity if they met >80% of criteria, "moderate" if they met 60-80% of criteria, and "low" if they met <60% of the criteria [45]. Internal and external validity was rated separately while the lower of the two was used in defining overall validity.…”

Reference values for gait temporal and loading symmetry of lower-limb amputees can help in refocusing rehabilitation targets

“…Lower-limb amputees tend to walk asymmetrically when looking at gait temporal and loading parameters, with more time spent and load exerted on the intact limb [ 1 – 9 ]. Temporal asymmetry is typically measured based on step or stance duration; loading asymmetry based the magnitude of the first peak of the vertical ground reaction force (GRF), and the impulse of GRF [ 2 , 3 , 6 , 10 ].…”

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

“…Thus, it may stimulate increased cadence and shorter strides [53,54]. Nevertheless, analyzing the gait characteristics in healthy young adults may be meaningful because several studies have reported the positive effects of gait training programs using treadmills [18][19][20][21][22][23][24][25][26]. Second, there were limitations in the direct comparisons of GV with previous studies because most previous studies focused on elderly adults (who ranged in age from 70 to 89 years).…”

“…By contrast, walking on treadmills may be more useful for the collection of data pertaining to numerous continuous walking steps in comparison with methods involving repeated and averaged patterns due to decreased space requirements, multiple repetitions of strides, and controllability of the walking speed [17]. Recently, many studies have reported the positive effects of gait training programs using treadmills on amputees [18] and pathological patients such as people suffering from cerebral palsy [19], Parkinson's disease [20][21][22][23][24][25], and spinal cord injury [26]. However, several studies reported limitations such as lack of controls [19,24,25] and relatively small samples of patients [20,22].…”