Chapter 10 - Rehabilitation: Gait, Amputations, Prostheses, Orthoses, and Neurologic Injury

Abstract

Gait cycle is divided into stance and swing phases, with 20%–30% of the gait cycle spent in double-limb support. Energy expenditure of walking decreases as the vertical and horizontal displacement of the body’s center of gravity is minimized. Muscle action across the joints is associated with the relationship of the joints of interest with ground reaction force, the mean loading-bearing vector throughout the gait cycle. Amputation may be indicated in multiple situations, including peripheral vascular disease, trauma, burn, tumor, infection, and congenital anomalies. More proximal amputation requires higher energy expenditure. The soft tissue in the residual limb serves as the interface in which load transfer or weight bearing takes place. Transected muscles can be sutured to antagonist muscles (myoplasty) or anchored directly to distal end of bone (myodesis), with the latter providing better residual limb control. Common complications of amputation include phantom limb sensation, pain (somatic and neuropathic), edema, joint contracture, and skin problems. The prosthetic systems for upper limb amputation can be myoelectric, traditional body-powered, or hybrid. Medicare functional classification level (MFCL) provides recommendations on prosthesis proscription for lower limb amputations. Abnormal prosthetic gait can be caused by prosthesis or patient factors. Orthoses, which are used to control the motion of certain body parts, can be indicated for the protection of long bones and unstable joints, support of flexible deformities, and substitution for functional deficits. Surgery can be considered for spasticity if maximal spontaneous motor recovery achieved rehabilitation and the patient retains adequate cognitive capacity, motivation, and body image awareness. Postpolio syndrome manifests as a new wave of weakness and is caused by dysfunction of motor units of alpha motor neurons that have expanded in size. The mainstay of treatment is limited exercise.