Gait re-education in transfemoral amputees The training programme, gait analysis, oxygen consumption and coping

Sammanfattning: A gait re-education programme, combining physiotherapy with a psychologically conscious therapeutic approach, was applied to nine unilateral transfemoral amputees, whose amputation was caused by trauma or tumour. The participants trained once a week for a mean 10 months. The median age was 33 years (range 16– 51). They had worn a prosthesis for more than 18 months and had completed conventional rehabilitation. Before treatment, walking ability was limited and three used walking aids. All had problems with low-back pain. The effects of training on gait pattern and gait speed were evaluated with a three-dimensional motion analysis system. Oxygen consumption and energy cost were measured by analysing expired gas and heart rate was measured by electrocardiogram. Semi-structured interviews were performed to describe coping strategies in the acute phase and over time. Results showed normalized gait speed comparable to healthy non-amputees of similar age, due to improved gait technique and walking skills. After treatment none needed walking aids and almost all low-back pain had disappeared. In addition, seven participants learnt to jog. Results indicate that this new approach may add skills, mostly on participation level, for leading a relatively normal life. The positive results remained at a six-month follow-up. The participants’ strategies for coping in the acute phase were denial and avoidance. Over time they used downward comparisons, positive comparisons and repression. Only one participant had fully accepted the situation and adjusted to the new norm. Future research will show whether these results can be generalized in a controlled study.