Feasibility of Moderate to High Intensity Gait Training in a Patient with Transfemoral Amputation

Abstract

Research Objectives To assess the feasibility of moderate to high intensity gait training in a person with TF amputation to improve walking outcomes. Design Case study: 3 months of intervention and 1 month follow-up. Setting Outpatient Physical Therapy. Participants 64 year-old female five months post TF amputation. PMH included HTN, PVD, DMII, and current smoker. Interventions The patient attended outpatient PT visits for 3 months (24 visits). The goal for each visit was to spend 40 minutes at 60-80% of their heart rate-reserved (HRR) in the context of walking. Main Outcome Measures Number of visits the HR goal was achieved, Amputee Mobility Predictor, 10 Meter Walk Test. Results Moderate to high intensity gait training was performed in 19 of the 24 visits. The average HR goal of at least 60% HRR achieved in 10 of the 19 gait training visits. When the HR goal was achieved, the intervention was performed for an average of 44.2 (±3.8) minutes. The HR goal was not achieved in 9 visits due to: intervention performed for less than 40 minutes, average HR was below 60% HRR-15, continuous HR monitoring not possible due to equipment failure, and pain (unrelated to the intervention). For 5 visits the intervention was not performed due to: elevated BP, prosthetic management, and monthly assessments. The patient demonstrated an increase in the Amputee Mobility Predictor AMpro by 6 pts and 9pts, 10 Meter Walk Test (10MWT) self-selected (SS) by 0.11m/s and 0.24m/s, and 10MWT (fast) by 0.1m/s and 0.19 at 1 and 3 months respectively, after starting the moderate to high intensity training. At one month post training, the AMpro decreased by 3 pts and 10MWT (SS) by 0.7m/s. There was however an increase in the 10MWT (fast) 0.12m/s. Conclusions Moderate to high-intensity gait training is safe and feasible in a patient with TF amputation and it improves walking outcomes. There were no adverse reactions to the intervention. The patient was on multiple medications for BP management that may have affected HR response making it more difficult to achieve the HR goal. Author(s) Disclosures None. To assess the feasibility of moderate to high intensity gait training in a person with TF amputation to improve walking outcomes. Case study: 3 months of intervention and 1 month follow-up. Outpatient Physical Therapy. 64 year-old female five months post TF amputation. PMH included HTN, PVD, DMII, and current smoker. The patient attended outpatient PT visits for 3 months (24 visits). The goal for each visit was to spend 40 minutes at 60-80% of their heart rate-reserved (HRR) in the context of walking. Number of visits the HR goal was achieved, Amputee Mobility Predictor, 10 Meter Walk Test. Moderate to high intensity gait training was performed in 19 of the 24 visits. The average HR goal of at least 60% HRR achieved in 10 of the 19 gait training visits. When the HR goal was achieved, the intervention was performed for an average of 44.2 (±3.8) minutes. The HR goal was not achieved in 9 visits due to: intervention performed for less than 40 minutes, average HR was below 60% HRR-15, continuous HR monitoring not possible due to equipment failure, and pain (unrelated to the intervention). For 5 visits the intervention was not performed due to: elevated BP, prosthetic management, and monthly assessments. The patient demonstrated an increase in the Amputee Mobility Predictor AMpro by 6 pts and 9pts, 10 Meter Walk Test (10MWT) self-selected (SS) by 0.11m/s and 0.24m/s, and 10MWT (fast) by 0.1m/s and 0.19 at 1 and 3 months respectively, after starting the moderate to high intensity training. At one month post training, the AMpro decreased by 3 pts and 10MWT (SS) by 0.7m/s. There was however an increase in the 10MWT (fast) 0.12m/s. Moderate to high-intensity gait training is safe and feasible in a patient with TF amputation and it improves walking outcomes. There were no adverse reactions to the intervention. The patient was on multiple medications for BP management that may have affected HR response making it more difficult to achieve the HR goal.