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REVIEW OF AMPUTEE GAIT TRAINING                           111



          increase safety, and increase amputees’ ability to par-  ACKNOWLEDGMENTS
          ticipate in their typical functional and recreational     Contents of this manuscript represent the opin-
          activities.                                   ions of the authors and not necessarily those of the
          Joint Kinematics and Loading                  U.S. Department of Defense, U.S. Department of
            Two studies were identified, resulting in low level   the Army, U.S. Department of Veterans Affairs, or
          confidence to support improved frontal and sagittal   any academic or health care institution. Authors
          plane joint kinematics when psychological awareness   declare no conflicts of interest. This project was
          training was integrated into a typical gait training pro-  partially funded by the National Institutes of Health
          gram (11,28). Two additional studies supported use of   Scholars in Patient Oriented Research (SPOR) grant
          an auditory feedback device to improve involved side   (1K30RR22270).
          loading (6,26). In patients with lower limb amputa-
          tion, joint loading in gait and in functional activities   REFERENCES
          is known to be altered and possibly connected with   1.  Zeigler-Graham K, Mackenzie EJ, Ephraim PL,
          long term secondary consequences (13,49). Therefore,   Travison TG, Brookmeyer R. Estimating the
          gait training interventions to mitigate these sequelae   prevalence of limb loss in the United States: 2005
          are needed.                                      to 2050. Arch Phys Med Rehabil. 2008;89:422-9.
                                                        2.  Dillingham TR, Pezzin LE, Mackenzie EJ. Limb
          Limitations                                      amputation and limb deficiency: epidemiology
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          concepts; however, they are not peer-reviewed and   4.  Feinglass J, Brown JL, LoSasso A. Rates of
          therefore were not included in this review.      lower-extremity amputation and arterial recon-
                                                           struction in the United States, 1979 to 1996. Am
          CONCLUSION                                       J Public Health. 1999;89:1222-7.
            Due to the gait asymmetries, altered biomechanics,   5.  Sauter CN, Pezzin LE, Dillingham TR. Functional
          and related secondary consequences associated with   outcomes of persons who underwent dysvascular
          lower extremity amputation, gait training interven-  lower extremity amputations. Am J Phys Med
          tions are needed. Eight evidence statements were   Rehabil. 2013;92:287-96.
          synthesized over two general areas of gait train-  6.  Yang L, Dyer PS, Carson RJ, Webster JB, Bo
          ing therapy: overground and treadmill training.   Foreman K, Bamberg SJM. Utilization of a lower
          Overground training with verbal or other auditory,   extremity ambulatory feedback system to reduce
          manual, and psychological awareness interventions   gait asymmetry in transtibial amputation gait.
          was found to be effective at improving gait. Similarly,   Gait Posture. 2012;36:631-4.
          treadmill-based training was found to be effective:   7.  Highsmith MJ, Schulz BW, Hart-Hughes S, Latlief
          1) as a supplement to overground training; 2) inde-  GA, Phillips SL. Differences in the spatiotempo-
          pendently when augmented with visual feedback    ral parameters of transtibial and transfemoral
          and/or body weight support; or 3) as one part of a   amputee gait. J Prosthet Orthot. 2010;22:26-30.
          home exercise plan. Gait training approaches studied   8.  Highsmith MJ, Kahle JT, Bongiorni DR, Sut-
          improved multiple areas of gait, including sagittal and   ton BS, Groer S, Kaufman KR. Safety, energy
          coronal biomechanics, spatiotemporal measures, and   efficiency, and cost efficacy of the C-Leg for
          distance walked. No adverse or safety events were   transfemoral amputees: a review of the litera-
          reported in connection with the studied interventions.   ture. Prosthet Orthot Int. 2010;34:362-77.
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