Aided gait of people with lower-limb amputations: Comparison of 4-footed and 2-wheeled walkers

Abstract

Tsai HA, Kirby RL, MacLeod DA, Graham MM. Aided gait of people with lower-limb amputations: comparison of 4-footed and 2-wheeled walkers. Arch Phys Med Rehabil 2003;84:584-91. Objectives: To test the hypotheses that prosthesis-wearing people with lower-limb amputations, using 2-wheeled walkers (TWW) versus 4-footed walkers (FFW), (1) walk faster, (2) walk with fewer interruptions, (3) walk no less safely, and (4) prefer the TWW. Design: Within-subject comparisons. Setting: Rehabilitation center. Participants: Twenty prosthesis-wearing people with lower-limb amputations (13 men, 7 women) with a mean age [plusmn] standard deviation of 69[plusmn]13 years. Of the subjects, 11 had unilateral transfemoral amputations, 7 had unilateral transtibial amputations, and 2 had bilateral transtibial amputations. Intervention: Participants were trained to use both walkers. Main Outcome Measures: Five-meter walking velocity, gait pattern, need for spotter intervention, foot position with respect to the base of support of the walker, and subject preference. Results: Subjects walked 28.5% faster when using the TWW ( P[equals].000). During gait cycles, 100% of subjects brought the FFW to a complete halt, whereas only 55%, particularly subjects with transfemoral amputations, halted the TWW ( P[equals].008). There was no difference in the need for spotter intervention. Subjects with unilateral amputations placed their feet significantly more anteriorly within the walker base of support when using an FFW ( P[equals].000). Fourteen subjects preferred the TWW, and 6 chose the FFW (not significant). Conclusion: The TWW allows prosthesis-wearing people with lower-limb amputations, especially those with transtibial amputations, to walk more quickly and with less interruption, but no less safely, than the FFW. The findings have implications for ambulation training and the prescription of ambulation aids.