Strategies for Gait Retraining in a Collegiate Runner with Transfemoral Amputation: A Case Report

Abstract

BackgroundMore than fifty percent of people with limb amputations participate in sports or physical activity following amputation. Athletes with limb amputations may face additional challenges including phantom limb pain (PLP), psychological barriers, prosthetic complications, and gait abnormalities. Prevalence of PLP in the general amputee population is estimated to be as high as 85%. Despite the high prevalence of PLP, there is little research regarding the use of gait training as a treatment for PLP among both the general amputee population and athletes. Case DescriptionA 20-year old female collegiate track and field athlete presented with phantom knee pain brought on with running. The athlete demonstrated deficits in core and hip strength as well as decreased single leg stability bilaterally. Running gait analysis revealed circumduction with the prosthesis for limb advancement and increased vaulting with push off on the sound (uninvolved) limb. Gait retraining strategies were implemented to address video analysis findings and create a more efficient running gait and address phantom limb pain symptoms. OutcomesRehabilitation and gait retraining strategies were effective in improving several clinical and functional outcomes in this case. Significant improvements were noted in PLP, running gait mechanics, and the patient's psychological and functional status as measured with a standardized outcome tool, the Patient-Reported Outcomes Measurement Information System ® (PROMIS ® ). DiscussionRunning gait training following amputation could be a crucial component of rehabilitation for athletes in an attempt to lessen pain while running, especially in those experiencing phantom limb pain (PLP). Utilization of a multidisciplinary team in the gait retraining process is recommended. There is a need for further research to determine the effects of running gait retraining for management of PLP in athletes with amputation.

EXPERTS’ PERCEIVED PATIENT BURDEN AND OUTCOMES OF KNEE-ANKLE-FOOT-ORTHOSES (KAFOs) VS. MICROPROCESSOR-STANCE-AND-SWING-PHASE-CONTROLLED-KNEE-ANKLE-FOOT ORTHOSES (MP-SSCOs)

“…Adding to this line of reasoning is the fact that retraining of compensatory gait patterns, such as circumduction, requires time and, hence, may delay an early, straightforward improvement in QoL. 17 Furthermore, the reported experts’ perception might be influenced by the German healthcare reimbursement decision making process, where QoL has just recently gained more importance.…”

“…17 Furthermore, the reported experts' perception might be influenced by the German healthcare reimbursement decision making process, where QoL has just recently gained more importance.…”

Athletic Disciplines Of Sprinting After Lower Extremity Amputation

“…Sportaši nakon amputacije suočavaju se s daljnjim izazovima pri povratku aktivnostima, uključujući fantomsku bol u udovima, psihološke prepreke, protetičke komplikacije i abnormalnosti hoda. 20 Fantomska bol u udovima (engl. Phantom Limb Pain, PLP) definira se kao bol koja potječe iz odsutnog dijela ekstremiteta.…”

“…Procjenjuje se da je prevalencija PLP-a u općoj populaciji amputiranih čak 85 %. 20 Iako je vježbanje hoda s protezom važna komponenta rehabilitacije nakon amputacije donjih ekstremiteta, ne mora završiti nakon što se postigne funkcionalna pokretljivost. Za trkače i druge sportaše s amputacijama trening hodanja može biti ključni aspekt rehabilitacije za olakšavanje sigurne mehanike tijekom viših razina tjelesne aktivnosti kao što su trčanje i sport.…”

“…Ključno je da sportaš stekne povjerenje u svoju protezu za trčanje koja se uvelike razlikuje od mogućnosti njegove svakodnevne proteze. 20 Svaku osobu s amputacijom koja je dosegnula razinu funkcije na kojoj se može učinkovito kretati uz dobar obrazac hoda treba poticati da razvije daljnja poboljšanja kako bi omogućila sudjelovanje barem u brzom hodanju, ali po mogućnosti i trčanju. 21…”