Visual gait analysis pocket-sized tool for rehabilitation of lower limb amputees

Abstract

Recovering a gait as close as possible to physiology is a real challenge after lower limb amputation. The objective of the multidisciplinary team, focused on amputee people, is to correct and ensure proper use of the prosthesis. However, to our knowledge, there are few studies which proposed personalized approach of motor learning. The aim of the study was to realize a visual gait analysis tool, considering gait cycle and the 3 motion planes, to be used by physiotherapists thanks to the knowledge of biomechanical analysis. This study was part of the project APSIC (ANR) which aimed at completing scientific knowledge about gait adjustment strategies to limiting daily living situations compared to level walking in transtibial (TT) and transfemoral (TF) amputees. Data collection was conducted in 2 centres (INI/CERAH-Créteil, IRR-Nancy). Twenty-one TF and 22 TT walked with their own prosthetic devices and shoes at their comfortable speed in a motion capture laboratory equipped with an optoelectronic system on five different surfaces (level ground, 2 slopes, cross-slope and stairs) instrumented with 3 AMTI ® force platforms. The main outcomes measures were the asymmetry in loading between prosthetic and intact limbs, the nonspecific adaptations (spatiotemporal and kinematic parameters) and specific strategies as vaulting and pelvic hike. In situations of daily living, amputees increased asymmetry in loading, pelvic hike and vaulting especially TF amputees. By these biomechanical results, a visual gait analysis tool was proposed considering gait cycle events (toe off, heel strike, double support, stance and swing phase) and the 3 planes (sagittal, horizontal, frontal) for TF and TT amputees. At each moment of gait cycle, the rehab professional objectives and the amputee guidelines focused on exteroception, proprioception and kinesthesia were listed on a pocket brochure. This study allowed to refine the gait rehabilitation by using the synchronisation of the three different sensitivities considering gait cycle events and the 3 motion planes by defining a couple “amputee-prosthesis”. The innovation was also the association of the rehab professional objectives and the amputee guidelines in the same pocket-sized tool. Its use will be very interesting for multidisciplinary team to decrease gait defaults in amputees.