Optimizing Gait Rehabilitation for Veterans With Non-Traumatic Lower Limb Amputation
VA Office of Research and Development
Summary
The population of older Veterans with non-traumatic lower limb amputation is growing. Following lower limb amputation, asymmetrical movements persist during walking and likely contribute to disabling sequelae including secondary pain conditions, poor gait efficiency, impaired physical function, and compromised skin integrity of the residual limb. This study seeks to address chronic gait asymmetry by evaluating the efficacy of two error-manipulation gait training programs to improve gait symmetry for Veterans with non-traumatic lower limb amputation. Additional this study will evaluate the potential of error-manipulation training programs to improve secondary measures of disability and residual limb skin health. Ultimately, this study aims to improve conventional prosthetic rehabilitation for Veterans with non-traumatic amputation through gait training programs based in motor learning principles, resulting in improved gait symmetry and lower incidence of long-term disability after non-traumatic lower limb amputation.
Description
The focus of this study is to improve walking symmetry in order to optimize walking ability and reduce disability for Veterans with non-traumatic lower limb amputation (LLA). Over 80% of current LLAs are non-traumatic, resulting from complications of pathologies, such as diabetes mellitus and peripheral artery disease. Despite current declines in total amputation rate among Veterans, the population with non-traumatic LLA is growing. For example, from 2000 to 2004 the relative amputation rate decreased by 34%. However, due to an increase in the number of Veterans with diabetes during the same p…
Eligibility
- Age range
- 40–89 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Unilateral, non-traumatic, transtibial amputation * Diabetes mellitus and/or peripheral artery disease * Able to ambulate in the community without assistive device * Step length asymmetry during walking (\>1.0 asymmetry index.) * 6 months since amputation Exclusion Criteria: * Unstable heart condition * Including unstable angina, uncontrolled cardiac dysrhythmia, acute myocarditis, hypertension, and acute pericarditis * Acute systemic infection * Active cancer treatment * Traumatic or cancer related amputation etiology
Interventions
- BehavioralError-augmentation gait training
Split-belt treadmill training to enhance between-limb asymmetry during treadmill walking, which is intended to force compensation and correction of step asymmetry during treadmill walking. The error-augmentation gait training program is delivered in 8 sessions over 4 weeks.
- BehavioralError-correction gait training
Metronome will be set to cue participants to overcorrect between-limb step asymmetry during treadmill walking, through use of asymmetrical metronome tones in a 2:1 ratio. The error-correction gait training program is delivered in 8 sessions over 4 weeks.
- BehavioralSupervised walking
An active comparator intervention, in which a supervised treadmill walking program is delivered without attempt to correct step asymmetry. The supervised walking program is delivered in 8 sessions over 4 weeks.
Locations (2)
- Rocky Mountain Regional VA Medical Center, Aurora, COAurora, Colorado
- Hunter Holmes McGuire VA Medical Center, Richmond, VARichmond, Virginia