Gait rehabilitation for a patient with an osseointegrated prosthesis following transfemoral amputation

Figures & data

Table 1. Prosthesis characteristics and quantitative outcomes.

Measurement		Pre-operative	End of rehabilitation	Six-month follow-up	One-year follow-up
Hip abductor	Sound side	278.0	320.7	240.3	233.5
strength (Newtons)	Prosthetic side	245.1	284.2	239.6	244.2
Maximum walking distance in everyday life (meters)		200	1500	100	1000
Cadence (strides per minute)		92	90	88	90
Prosthesis wearing time (hours a day)		16	17	17	17
Use of walking aid in everyday life		no	no	Yes (2 crutches)	no
SIGAM WAP mobility scale (A–F)		E	F	E	F
Q-TFA global score (0–100)		50	75	58	75
PCS (0–10)		6	9	8	9
ISO Stump characteristics (centimeters)	P circumference	55	62	58	61
	D circumference	42	41.5	42	45
	Length	20	17	18	18
Length of the residuum as a percentage of sound side length		25	21	23	23
LBP (no/sporadically/yes)		sporadically	no	sporadically	no
Prosthesis parts	Socket	Hybrid socket	Not relevant	Not relevant	Not relevant
	Knee	K3-4: 3R92 (Otto Bock)	K3-4: 3R92 (Otto Bock)	K3-4: 3R92 (Otto Bock)	K3-4: C-Leg (Otto Bock)
	Foot	K1-2: Multiflex (Endolite)	K2-3: 1C30 Trias (Otto Bock)	K2-3: 1C30 Trias (Otto Bock)	K2-3: 1C30 Trias (Otto Bock)

SIGAM WAP: Special Interest Group in Amputation Medicine Workgroup Amputation and Prosthetics (Rommers et al., 2008); Q-TFA: Questionnaire for patients with a transfemoral amputation (Hagberg, Branemark and Hagg, 2004); PCS: Prosthesis Comfort Score; ISO: International Organization for Standardization (International Standards Organization, 1993); P: proximal; D: distal; LBP: Lower Back Pain; Prosthesis parts: K-level (scale 0–4) and type part/manufacturer.

Table 2. Radboud Amputation rehabilitation protocol for EEFP; 13-week rehabilitation program.

Supervised training sessions:	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26
Phase 1 (short prosthesis):
1) Symmetric posture training	x^1	x	x	x
2) Pelvic shift	x^1	x^2	x^3	x^4
3) Active pelvic tilt	x^1	x^2	x^3	x^4
4) Entire stance phase		x^2	x^3	x^4
5) Hip mobility/strength and core stability	x	x	x	x
6) Fall and rise up strategies				x
7) Pendulum exercises				x
Phase 2 (full length prosthesis):
1) Hip mobility/strength and core stability					x	x	x			x	x
2) Using the click-safety adapter					x	x
3) Symmetric posture training					x	x	x	x	x	x	x	x	x	x	x
4) Pelvic shift					x	x	x	x	x	x	x	x	x	x	x	x	x	x	x	x
5) Active pelvic tilt					x	x	x	x	x	x	x	x	x	x	x	x	x	x	x	x
6) Entire stance phase					x	x	x	x	x	x	x	x	x	x	x	x	x	x	x	x
7) Swing phase							x	x	x	x	x	x
8) Gait training between bars								x	x	x	x			x	x
9) Gait training with 2 crutches in 3-point gait								x		x	x	x	x	x	x	x
10) Gait training with 2 crutches in 2-point gait											x	x	x	x			x	x	x
11) Gait training with 2 canes in 2-point gait												x	x	x	x	x	x	x	x	x	x	x	x	x
12) Gait training without walking aids															x	x	x	x	x	x	x	x	x	x
13) Stair climbing																			x	x	x	x
14) Gait training at different velocities												x		x	x	x	x	x	x	x	x	x	x	x
15) Gait training on uneven surfaces												x		x	x	x	x	x	x	x	x	x	x	x
16) Several gait forms: sideways, backwards, stopping, turning, slalom															x	x	x	x	x	x	x	x	x	x
17) Gait training on slopes																				x		x
18) Fall and rise up strategies																							x
19) Gait training with obstacles																							x	x
20) Gait training and skills with dual tasks																					x		x	x
21) Circuit training																							x	x
22) Cycling																							x	x
23) Pendulum exercises						x		x				x					x	x	x
24) Cycling on a stationary bike						x		x				x

¹: maximum of 40 kg; ²: maximum of 60 kg; ³: maximum of 75 kg; ⁴: maximum of 81 kg = General rehabilitation timetable; x = Patient’s actual progress.

Figure 1. Flowchart showing clinical reasoning.

Figure 2. Timeframe of the measurements and the interventions. T: follow-up moment.

Picture 1

Rommers GM, Ryall NH, Kap A, De Laat F, Van der Linde H 2008 The mobility scale for lower limb amputees: the SIGAM/WAP mobility scale. Disability and Rehabilitation 30: 1106–1115.

 PubMed Web of Science ®Google Scholar

Hagberg K, Branemark R, Hagg O 2004 Questionnaire for Persons with a Transfemoral Amputation (Q-TFA): Initial validity and reliability of a new outcome measure. Journal of Rehabilitation Research and Development 41: 695–706.

 PubMed Web of Science ®Google Scholar

International Standards Organization 1993 ISO 8548-2. Prosthetics and Orthotics - Limb Deficiencies - Part 2: Method of Describing Lower Limb Amputation Stumps. Geneva.

 Google Scholar