GAIT TRAINING IN TRANSTIBIAL PROSTHESIS

Definition

It is the process in which the amputee with new prosthetic fitting is trained to adopt a gait which is as close to the normal as the modern technology will allow.

                The importance of proper gait training can not be negotiated. Some of the amputee’s think that there is no need of proper training under the supervision of therapist. It a positive thing but could not be promoted at any cast. The reason is that new amputees are not habitual to use the prosthesis and there is some muscle weakness is present there. And there are also the chances of contracture development which again complicate the prosthetic fitting.

                Amputee, physical therapist and Prosthetist will work as a team to make the rehabilitation as quick and successful as possible. Almost 3 to 9 months are taken by an amputee to gain normal strength of his limb after prosthetic fitting. And there for a proper gait training is vital for the refined movements and for the better control on the prosthesis.

Techniques to Walking

There are a few very important and simple techniques you should know. Then you can trained the amputee so that he/she can safely and naturally walk with prosthesis. It is very important that you take the time to learn these basic fundamentals so that you can develop good gait habits in an amputee.

·         Beginning a step: Each time when amputee stand to walk, he/she needs to always begin by taking a step with his/her prosthesis first.

·         Descending stairs: Prosthetic side should be placed first on stair bellow and followed by sound side.

·         Ascending stairs: Totally opposite to the descending pattern, amputee should lead with his/her sound (good) leg.

 Proper Weight Transfer

·         Another technique which is very important for an amputee to learn is the proper transfer of his/her body-weight on to the prosthesis side.

·         When an amputee put his/her full body weight on the prosthesis he/she should need to shift the body towards the prosthesis confidently; this is called weight transfer.

·         It is emphasized on confidence because for some new amputees it is difficult for them to shift their full weight onto prosthesis because they don’t feel secure with their prosthesis yet.

·         Proper transfer of amputee body weight is important for good walking.

·         The comfort of the prosthesis should never prevent the amputee from putting full weight onto the prosthesis.

·         In case of pain or discomfort that prevents the amputee from fully using the prosthesis he/she should contact their Prosthetist immediately.

  Proper Foot Placement

·         Another fundamental technique is proper foot placement. There are two considerations when an amputee initiating foot placement:

1.    Width of the foot placement (how far apart amputee’s feet are) – The ideal distance (measured heel to heel) is 2-4 inches. As the amputee begin to walk, consider these two conditions

a.     Placing the prosthetic foot wider than 2-4 inches will make the gait more stable, which is sometimes good, but it will increase the energy required to walk. And gait becomes wide base gait and lateral trunk bending may occur.

b.    On the other hand, narrow foot placement, less than 2-4 inches, will make the gait less stable but will decrease the energy required to walk. And heel knocking may occur.

2.    Length of the step (how far you place your front foot in front of you) – This is called step length. Ideal step length is a distance equal to the sound side of the amputee. Basically amputee needs to maintain the equal step length on both sides. If you think about it, it wouldn’t look very natural if amputee took a long step with one leg and a short step with the other leg.

a.     On starting gait training, it is recommend taking “heel to toe” steps.

b.    Place the heel of the prosthetic foot no farther than the toe of the sound side; repeat the same with the next step.

c.     As the confidence builds, amputee will automatically begin to increase the step length. Step length also increases as the walking speed increases.

d.   As faster the walk, as greater the step length.

Troubleshooting

·         Now a day’s advancements in technology have brought a lot of exciting materials to the prosthetic industry.

·         Materials such as acrylic resins, carbon fiber, titanium, silicone and urethane have made prostheses stronger, lighter and more comfortable. Even though callous formation is no longer a common occurrence, fitting problems still occur.

·         While some of the socket fitting problems will require a visit of the Prosthetist.

Some of the common problems and their solutions

Problems	solutions
Pressure on the Anterior distal end of the stump	·         Try adding a one or two ply sock. ·         Recently changed shoes ·         Try one with a lower heel ·         planter flexed foot ·         weight line too far posterior from normal
Pressure on the patellar tendon
Feel like walking down a hill	Dorsiflexion of foot
Pain on the bottom-back of your calf
Feel like walking up a hill	Plantarflexion of  foot
Pressure on the sides of the knee	Medio-lateral dimensions are more

Note

·         Remember, the most common remedy to most socket-fitting problems is adding or removing socks.

·         Prosthetic socks plays an important role in keeping the residual limb comfortably seated within the prosthesis.

·         If the prosthesis is uncomfortable, four out of five times it is because amputees are not wearing the proper amount of prosthetic socks.

·         Vary the sock ply until the prosthesis feels better.

·         If this does not fix the problem, check the measurements other technical faults.