title: Home-based treadmill training to improve gait performance in persons with a chronic transfemoral amputation.
abstract: OBJECTIVE
  To investigate the effectiveness of a home-based multiple-speed treadmill training program to improve gait performance in persons with a transfemoral amputation (TFA).
  
  
  METHODS
  Repeated measures.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Individuals with a TFA (N=8) who had undergone a unilateral amputation at least 3 years prior as a result of limb trauma or cancer.
  
  
  METHODS
  Home-based treadmill walking for a total of 30 minutes a day, 3 days per week for 8 weeks. Each 30-minute training session involved 5 cycles of walking for 2 minutes at 3 speeds.
  
  
  METHODS
  Participants were tested pretraining and after 4 and 8 weeks of training. The primary measures were temporal-spatial gait performance (symmetry ratios for stance phase duration and step length), physiological gait performance (energy expenditure and energy cost), and functional gait performance (self-selected walking speed [SSWS], maximum walking speed [MWS], and 2-minute walk test [2MWT]).
  
  
  RESULTS
  Eight weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. A relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps produced the improved symmetry. The training effect was significant for the step length symmetry ratio within the first 4 weeks of the program. Energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds. SSWS, MWS, and 2MWT all increased by 16% to 20%.
  
  
  CONCLUSIONS
  Home-based treadmill walking is an effective method to improve gait performance in persons with TFA. The results support the application of training interventions beyond the initial rehabilitation phase, even in individuals considered highly functional.
authors: Department of Physical Therapy, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA. Electronic address: bjdarter@vcu.edu.
authors: Benjamin J
authors: BJ
authors: Darter
authors: Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors: David H
authors: DH
authors: Nielsen
authors: Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors: H John
authors: HJ
authors: Yack
authors: Department of Health and Human Physiology, College of Liberal Arts and Science, University of Iowa, Iowa City, IA.
authors: Kathleen F
authors: KF
authors: Janz
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000673:Amputation, Traumatic / Q000534:rehabilitation*; D000674:Amputees; D001186:Artificial Limbs; D004734:Energy Metabolism / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D016138:Walking / Q000502:physiology*
keywords: 2-minute walk test; 2MWT; Amputees; EC; EE; Energy metabolism; Exercise; LEA; Locomotion; MWS; Rehabilitation; SSWS; TFA; energy cost; energy expenditure; lower extremity amputation; maximum walking speed; self-selected walking speed; transfemoral amputation
references: J Rehabil Res Dev. 2001 Jul-Aug;38(4):379-84
references: 11563490
references: J Vasc Surg. 2005 Aug;42(2):227-35
references: 16102618
references: Arch Phys Med Rehabil. 1987 Apr;68(4):244-7
references: 3566520
references: Clin Rehabil. 2004 Dec;18(8):833-62
references: 15609840
references: Cochrane Database Syst Rev. 2012 Nov 14;11:CD006676
references: 23152239
references: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007830
references: 20091652
references: Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7
references: 12091180
references: J Am Geriatr Soc. 2006 May;54(5):743-9
references: 16696738
references: Phys Ther. 2011 Sep;91(9):1385-94
references: 21757579
references: Phys Ther. 2006 Jun;86(6):809-16
references: 16737406
references: Int J Sports Med. 2001 May;22(4):280-4
references: 11414671
references: Am J Phys Med Rehabil. 2002 May;81(5):321-5
references: 11964571
references: Arch Phys Med Rehabil. 2013 Sep;94(9):1714-20
references: 23466292
references: Scand J Rehabil Med. 1973;5(2):88-101
references: 4695245
references: Arch Phys Med Rehabil. 1987 Dec;68(12):858-61
references: 3426386
references: Neurorehabil Neural Repair. 2001;15(2):105-12
references: 11811252
references: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002840
references: 16235304
references: Prosthet Orthot Int. 2002 Aug;26(2):101-12
references: 12227444
references: J Rehabil Med. 2001 Mar;33(3):114-8
references: 11482351
references: Arch Phys Med Rehabil. 2012 Aug;93(8):1384-91
references: 22465582
references: Arch Phys Med Rehabil. 1993 May;74(5):521-5
references: 8489363
references: J Bone Joint Surg Am. 1987 Jul;69(6):914-21
references: 3597505
references: Br J Surg. 1994 Nov;81(11):1596-9
references: 7827880
references: J Rehabil Res Dev. 2001 Jan-Feb;38(1):7-11
references: 11322473
references: J Bone Joint Surg Am. 1976 Jan;58(1):42-6
references: 1249111