title: Gait training with virtual reality-based real-time feedback: improving gait performance following transfemoral amputation.
abstract: OBJECTIVE
  Gait training is an important component of rehabilitation after lower-extremity amputation. Abnormal gait performance often persists even for individuals who reacquire a high level of function. This case report describes the use of a virtual reality (VR)-based gait training program that provides real-time feedback in order to improve biomechanical and physiological performance. The aim of this case report is to describe the effects of the training in a person with a transfemoral amputation.
  
  
  METHODS
  A 24-year-old man with a transfemoral amputation completed a 3-week gait training program. The intervention consisted of 12 sessions of treadmill walking with real-time visual feedback on full-body gait kinematics. A treating therapist directed the patient's attention to specific gait deviations as a means to normalize gait biomechanics.
  
  
  RESULTS
  The patient completed overground biomechanical gait analyses and multiple-speed treadmill tests 3 weeks apart prior to and following the training program. Biomechanical gait analyses indicated the training produced improved frontal-plane hip, pelvis, and trunk motion during overground walking. Improvement in trunk motion was observed at the posttraining test, and improvements in pelvis and hip motion were observed at the 3-week follow-up test. Decreases of up to 23% in oxygen consumption also were demonstrated.
  
  
  CONCLUSIONS
  Although the exact contribution of the visual feedback could not be isolated, the training was effective in improving the patient's walking performance. Biomechanical data suggest correcting trunk motion and increasing hip abductor strength (force-generating capacity) may be important in facilitating improvements at the pelvis and hip. Observed improvements in oxygen consumption were significantly larger than achieved through previously reported interventions.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Center for the Intrepid, Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA. benjamin.darter@us.army.mil
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Darter
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wilken
mesh_terms: D000673:Amputation, Traumatic / Q000534:rehabilitation*; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D001753:Blast Injuries / Q000601:surgery*; D005246:Feedback; D005684:Gait / Q000502:physiology*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D055815:Young Adult