Effectiveness of balance and gait training on transtibial amputees coming to PRH: A Pilot Randomized Control Trial

NEED FOR STUDY

Literature suggests higher prevalence of transtibial amputation in India.

Individuals with transtibial amputations often face challenges in maintaining optimal balance and gait, impacting their overall mobility and quality of life. While prosthetic advancements have improved functional outcomes, there is a paucity of research specifically addressing the effectiveness of balance and gait training interventions in this population.

This study aims to explore the potential benefits of targeted balance and gait training in enhancing the functional capabilities of transtibial amputees receiving care at a tertiary center.

AIM

To Determine The Effectiveness Of The Balance And Gait Training Programme Amongst Transtibial Amputees Coming to Tertiary Care Hospital.

Objectives

1.To study the effectiveness of balance and gait training in transtibial amputees.

2.To determine the functional status of pre and post training in transtibial amputees using the Amputee Mobility Predictor (AMPPRO)

3.To evaluate the risk of fall pre and post training in transtibial amputees using the timed up and go test (TUG)

INCLUSION CRITERIA

·Participants with Unilateral Transtibial Amputation

·Aged between 25 to 59 years

·Males and females

·1 year post amputation

·AMPPRO – K1-K3 Level

E****xclusion criteria:

Participants excluded will be:

·       Bilateral Transtibial Amputation

·       AMPPRO level: K4

·       Un healed scar tissue.

·       Recent Surgical Interventions

·       Co-morbidities affecting the everyday physical activity of the patient.

·       Unstable Prosthetic Fit

Outcome measures used for this study will be as follows,

·       Pain- measured with Visual Analogue scale, the reliability value r = 0.81- 0.99.

·       Functional status- measured with Amputee Mobility Predictor (AMPPro), the test-retest reliability r= 0.81- 0.89.

·       Fall risk- measured with Timed Up and Go test

Phase 1

Exercise Duration

•        40 minutes/session

•        Resistance training

•        10 RM target

EXERCISE PROTOCOL

1.     Hip abduction in side lying

2.     Hip extension in prone lying

3.     Hamstring curls in prone lying

4.     Hip Adduction in side lying

5.     Pelvic Bridging

6.     Tibialis anterior (of sound leg) in long sitting using theraband

7.     Plantarflexors in standing with support performing heel raises

8. Minisquats (without resistance)

Phase 2 (5th -8th session)

·        Balance

1.      Sit to Stand with arms crossed over the torso

2.      Standing on BOSU disc with the sound leg with continuous visual feedback.

3.      Weight shifts on sound leg with (pelvis squared)

4.      Side Stepping on towards the sound leg

5.      30 seconds eyes closed challenge

6.      Perturbations to improve stepping, ankle and hip strategies

7.      Equal weight bearing on both limbs followed by catching a ball

 Â·       Gait

1.     Asking the patients walk on mat with appropriate foot prints in a parallel bar.

2.     Step up with initiating the sound leg and step down using the affected limb.

3.     Tandem walking

4.     Walking with therapist supervision and following appropriate commands.

Phase 3 (9th to 12th session)

·       Balance

1.     Standing on BOSU disc with the prosthetic limb bearing weight.

2.     Ball rolling exercise (patient will roll a ball which is placed under the sound limb while bearing complete weight on the prosthetic limb)

3.     Goal oriented task i.e. asking the patient to touch a pint in all directions using the sound leg while bearing weight on the prosthetic leg

4.     Lateral stepping towards the prosthetic side.

GAIT  TRAINING

1. Initiate to stair climbing using by stepping with the prosthetic limb before followed by the sound limb
2. Obstacle walking (placing cones or any tiny object and asking the patient to avoid the obstacle)
3. Making sharp turns (at 180 degree)