A Method for Training Step-Over-Step Stair Descent Gait With Stance Yielding Prosthetic Knees

Abstract

In Brief Limited information is available concerning stair descent training for transfemoral amputees using prosthetic knees. Literature describing stair descent training techniques are predominantly available for the step-to-step stair descent method. A thoroughly descriptive technique for training prosthetic knee users to reciprocally descend stairs, using a step-over-step pattern is not available. The purpose of this technical note is to describe a procedure for training stance-yielding prosthetic knee users how to descend stairs using a reciprocal, step-over-step pattern. The technique describes stair setup, safety considerations including hand railing, use of a gait belt, guarding techniques and a one versus two therapist technique. Nineteen subjects were initially trained in this technique, and all subjects demonstrated the ability to reciprocally descend stairs after training. Reciprocal step-over-step stair descent is not appropriate for all transfemoral amputees; however, we recommend considering the supervised, therapeutic application of this technique for all transfemoral amputees using stance yielding prosthetic knees. We suggest that practicing this technique might improve a prosthetic knee user's overall functional performance such as their ability to utilize stumble recovery during a missed step, to transition more symmetrically from stand to sit and to utilize knee flexion during the loading response of gait. This technical note presents a strategy for training the transfemoral amputee how to utilize the reciprocal stair descent capability of stance yielding knees and offers considerations to expand for individualized functional needs. The technique is associated with positive clinical outcomes data, but the task of reciprocal stair descent is probably not appropriate for all transfemoral amputees utilizing stance yielding prosthetic knee mechanisms. Whether or not a patient ever utilizes the technique in daily life, training such patients with a comparable technique, at least therapeutically, may have functional significance in other daily activities such as stumble recovery during a missed step, in moving from stand to sit, and during the loading response of gait.