Basics of prosthetic gait training
Stability, particularly at the knee, is the major challenge that confronts the prosthetic user during gait, regardless of the level of the amputation.
Prosthetic alignment and design enhances knee stability in at least two ways:
- Prosthetic feet are relatively stiff. In addition to providing swing phase dorsiflexion, the stiffness also restrains tibial (shank) advancement during stance. Restraining shank movement prevents knee flexion during stance.
- Prosthetic alignment can maintain ground reaction force (GRF) in front of the knee joint through most of stance.
People who wear prostheses learn during gait training to activate the muscles that
- enhance stability (by controlling the residual and prosthetic joints, particularly the knee)
- provide propulsion
The target muscles include:
- hip extensors
- pelvic rotators
- hip abductors
- hip flexors
Therapeutic exercises strengthen these muscles and address potential muscle imbalances:
- hip adductor / abductor imbalance in the transfemoral amputee
- gluteus maximus shortening
- hip flexor shortening
Although research into motor learning leads therapists to prefer a direct and functional approach to gait training, certain traditional gait training drills and exercises can help when individuals must remedy specific deficits.