Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation.
OBJECTIVE
Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment. This case report describes walking function and mediolateral stability outcomes of an individual with a unilateral transfemoral amputation following a novel perturbation-based gait training intervention in a virtual environment.


METHODS
The patient was a 43-year-old male veteran who underwent a right transfemoral amputation 7+ years previously as a result of a traumatic blast injury. He used a microprocessor-controlled knee and an energy storage and return foot.


RESULTS
Following the intervention, multiple measures indicated improved function and stability, including faster self-selected walking speed and reduced functional stepping time, mean step width, and step width variability. These changes were seen during normal level walking and mediolateral visual field or platform perturbations. In addition, benefits were retained at least 5 weeks after the final training session.


CONCLUSIONS
The perturbation-based gait training program in the virtual environment resulted in the patient's improved walking function and mediolateral stability. Although the patient had completed intensive rehabilitation following injury and was fully independent, the intervention still induced notable improvements to mediolateral stability. Thus, perturbation-based gait training in challenging simulated environments shows promise for improving walking stability and may be beneficial when integrated into a rehabilitation program.
R.C. Sheehan, PhD, Military Performance Lab, Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA, Fort Sam Houston, TX 78234 (USA). riley.c.sheehan.ctr@mail.mil.
Riley C
RC
Sheehan
C.A. Rábago, PT, PhD, Military Performance Lab, Center for the Intrepid, Brooke Army Medical Center and Extremity Trauma and Amputation Center of Excellence, JBSA, Fort Sam Houston, Texas.
Christopher A
CA
Rábago
J.H. Rylander, PhD, Department of Mechanical Engineering, Baylor University, Waco, Texas.
Jonathan H
JH
Rylander
J.B. Dingwell, PhD, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas.
Jonathan B
JB
Dingwell
J.M. Wilken, PT, MPT, PhD, Military Performance Lab, Center for the Intrepid, Brooke Army Medical Center and Extremity Trauma and Amputation Center of Excellence, JBSA, Fort Sam Houston, Texas.
Jason M
JM
Wilken
D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D005269:Femur / Q000601:surgery; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D000066908:Simulation Training; D014584:User-Computer Interface