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106 HIGHSMITH ET AL. REVIEW OF AMPUTEE GAIT TRAINING 107

Table 4. Internal Validity Assessment of Included Manuscriptss
Table 4. Internal Validity Assessment of Included Manuscript

lower extremity amputee. MPH: miles/hour. TM: treadmill. CAREN: computer assisted rehabilitation environment. WB: weight bearing. PT: physical therapy. Amb:
ambulation. LEAFs: lower extremity feedback system. Grp: group. PNF: proprioceptive neuromuscular facilitation. SEW: symmetry of external work. SSWS: self-
*High overall quality score. All other studies were Moderate quality.‡Denotes a treadmill training study. All other studies used overground gait training. BWSTT:
body weight supported treadmill training. BWS: body weight support. BW: body weight. NR: not reported. EWA: early walk aid. FWB: full weight bearing. LEA:
Conclusions SEW improved in K2 amputees trained to use K3 Gait adaptation occurred w/ functional prosthesis. Unclear benefit at d/c after using either EWA. Partial BWSTT improved speed & gait pattern. Home TM training improved TFA gait. Consider use 12 sessions w/ real-time feedback improved TFA gait. Clinically important changes in biomechanics & VO2. Pts improved WB thru PL w/ auditory
proprioceptive neuromuscular facilitation. SEW: symmetry of external work. SSWS: self-selected walking speed. STS: sit to stand. TTA: transtibial amputee.

5
Mod


2002 Sjodahl et al.




E5


prosthetic feet. after initial rehab. community integration. loading response. improved in 10 d protocol. safety. 2001 Sjodahl et al. E5                8 Low
2002 Yigiter et al.
E1

4

Mod













2003 Sjodahl et al.

E5


Mod







4



O6


Low






7
2003 Cole et al.

2005 Faucher et al.

7

O6

Low






2006 Black et al.
1



2006 Isakov et al. O6                9 Low

Low
E1

Mod
5

2009 Barnett et al.

E3










2009 Hyland et al.

High



2









E1


7

2011 Darter et al.

O6

Treatment Duration 1-4 h x 10-14 d accommodation Individual need; Rehab duration 78.1 ± 25.3 (40–126 ) d 2x/wk x 8 sessions x 4.5 wks 12 x 30 min sessions x 3 wks 4 x 30 min sessions x 14 d 12 x 30 min sessions; 3x/wk 20-40 min; 3x/wk x 2 wks 1x/wk x 10 mos (range 7-14) 6 x 30 min sessions x 3 wks 30 min/d x10 sessions *High overall quality score. All other studies were Moder
Low








Low

X2
11
2012 Highsmith et al.


2013 Agrawal et al.


3



Mod
E3




E3





4

2013 Darter et al.



Mod

2
2014 Lamberg et al.
3x/wk x 8 wks

High
E2












12 sessions
period/ foot


Low


O6
2014 Mikami et al.

6



2014 Highsmith et al.

1

X2

Low




10 d
10 d
Boxes that are blacked out are not applicable for the specific study design and thus do not count as threats to validity.
Boxes that are blacked out are not applicable for the specific study design and thus do not count as threats to validity. A dot in the box
NR
NR
A dot in the box indicates the criteria was identified by reviewers whereas a blank box represents a criteria not
indicates the criteria was identified by reviewers whereas a blank box represents a criteria not identified.
identified. that gait training focused on practicing components of
Treatment (Independent Variables) SACH, SAFE, Talux, Proprio; Foot type specific training Pneumatic Post-Amputation Aid; Amputee Mobility Aide 50-60% BWSTT at 1.0-1.6mph 30 min home-based TM training Visual feedback via CAREN VR system & verbal PT feedback In-shoe BW measurement w/ audio feedback; PT feedback for FWB BWSTT (30% BWS), gradually ↓ by 5% intervals; TM w/out support

vational gait scales and perceptive and functional

initiating the task as a whole was an effective strategy
the clinical setting.

to improve overground ambulation and stair negotia-
Overground Gait Training

tion. Superiority of part task versus whole task training

Of the articles included in this review, 13 included
has long been debated (39-41). Here, it seems there is

some form of overground gait training. Multiple
merit in both approaches. For instance, Highsmith et

therapeutic gait interventions, including in-shoe
al. advocated one scenario where breaking down the

auditory feedback (6,26), verbal and tactile cues
subparts of a complex skill (i.e., stair ascent) enabled

training (16,17,25), early weight-bearing (30), early

training as part of a home exercise plan incorporates
Table 3. Extracted Study Data Table 3. Extracted Study Data N Author (Yr) 10 Agrawal et al. (2013) 15 Barnett et al. (2009) 1 Black et al. (2006)‡ 8 Darter et al. (2013)‡ 1 Darter et al. (2011)‡ 42 Isakov et al. (2006) Lamberg et al. 8 (2014)*‡ 1 Mikami et al. (2014)‡ 9 Sjodahl et al. (2001) 27 Sjodahl et al. (2002) 27 Sjodahl et al. (2003) 3 Yang et a

walking aids (32), part or whole task training (31), and
whole task training that has also proved effective (33).

This evidence statement is based on one randomized
combined PT and psychological awareness training

(11,27,28), were identified in our literature review.
control trial (31), one case study (29), and two expert
opinions (16,17).
Sufficient evidence provided moderate confidence