Feasibility of Underwater Treadmill Training to Improve Mobility

Abstract

Underwater treadmill training (UTT) has been shown to be successful in improving health related fitness in inactive populations with reduced mobility. Walking on a treadmill submerged in a self-contained tank of water allows for precise control of walking speed, water depth, and water temperature while unloading one’s body weight. PURPOSE The purpose of this study was to determine the feasibility and efficacy of an 8-week (3d[BULLET OPERATOR]wk-1) UTT program in a unilateral, transtibial amputee with limited ambulation potential. The hypothesis was that the participant’s post-UTT and three month scores relative to pre-UTT scores would improve in mobility (Amputee Mobility Predictor [AMP]), walking speed (10-M Walk Test), balance (single leg stance and Romberg test), and fall risk (Timed-Up-And-Go [TUG]). METHODS The patient was a 72 year-old male who underwent transtibial amputation for the development of an infection coupled with Charcot neuroarthropathy. He has used a prosthetic device two years. He walks with a cane in the community and uses a wheelchair while at home. Mobility is defined by the Medicare Functional Class K-Level system with stages ranging from K-0 to K-4 and is determined by the score of the AMP. Prior to UTT, a prosthetist administered the AMP and classified the patient as a K-2 with a total score of 32. The patient had a secondary prosthetic limb which was fitted by the prosthetist for use in the underwater treadmill. RESULTS After UTT, the patient was classified as a K-3 with a total score of 37. Time to complete the 10 M Test was 12.8 s before, 11.4 s after, and 11.1 s at 3-months. TUG test times pre, post, and 3 months post-UTT were 15.6 s, 13.5 s, and 13.3 s, respectively. The patient was unable to balance for 30 s with eyes closed before UTT and was able to complete this task after UTT and 3-months post-UTT. He was unable to perform a single leg balance test without assistance for 30 s on either limb at any time-point. Total underwater treadmill walking time increased from 26 min to 48 min and walking speed increased from 1.1 mph to 1.6 mph. CONCLUSION: Following UTT, the patient achieved a higher K-level. Patients classified as a K-3 or higher are eligible for health care coverage for higher level componentry for the prosthetic device. His walking speed improved and fall risk decreased following UTT with only minor improvements in balance.