title: Gait Training Interventions for Lower Extremity Amputees:A Systematic Literature Review.
abstract: Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked.
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA.
authors.forename: M Jason
authors.initials: MJ
authors.lastname: Highsmith
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Casey R
authors.initials: CR
authors.lastname: Andrews
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Millman
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Fuller
authors.affiliation: OP Solutions, Tampa, FL, USA; Prosthetic Design + Research, Tampa, FL, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Kahle
authors.affiliation: Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Klenow
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Lewis
authors.affiliation: Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Bradley
authors.affiliation: Shimberg Health Sciences Library, University of South Florida, Tampa, FL, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Orriola
keywords: Amputee; Physical therapy; Prosthesis; Rehabilitation; Therapeutic exercise; Trans-femoral; Transtibial; Treadmill