The Development Of A Gait Evaluation Method For Juvenile Amputees

Marjorie Agate, R.P.T.


Since the philosophy of fitting the child below-knee amputee with the Patellar Tendon-Bearing Prosthesis has been accepted by a number of clinics, New York University-Child Prosthetic Studies has undertaken an investigation of the long-term effects of this prosthesis on the juvenile amputee population. Gait analysis has emerged as a significant aspect of the research in this study.

Previous programs have given primary emphasis to prostheses and training techniques for the adult below-knee amputee. In 1956, Graham and Kramer (1) formalized checkout procedures for the clinic team to determine the adequacy of the prosthesis in terms of its quality and function. Their widely accepted gait evaluation scheme is based on normal adult gait pattern and included factors related to variations occurring during swing and stance phases, toe-out, base of support, and dorsi-plantar flexion of the foot. With the advent of the Patellar Tendon-Bearing Prosthesis, additional items given particular focus were

  1. Knee flexion on heel strike

  2. Lateral thrust at mid-stance

  3. Abrupt flexion at toe-off (drop-off)

  4. Abrupt extension at toe-off (2)

Development of Walking Pattern

Although the young child follows a fairly consistent pattern of growth and development, his gait characteristics depend upon his individual neuromuscular maturation. He progresses from sitting to standing balance and, finally, independent ambulation. Clinical experience has led to treatment as early as six months of age in order to provide the two essential points of support for standing balance and reciprocation (3). Continual supervision by informed parents and teachers, as well as the physical therapist, is necessary to develop walking patterns that are as normal as possible.

Criteria for evaluation of the gait of the adult amputee do not apply to the pre-school child amputee, and to the best of our knowledge, no systematic scheme for the gait analysis of the juvenile amputee is in general use. A rational method of evaluation of the child amputee gait should take cognizance not only of the type of amputation and the prosthesis under study, but the age, activity and maturation level of each child as well. For example, what constitutes "a reasonably narrow base of support" for a two-year-old child? What should be expected in terms of hip and knee flexion, heel-toe transition, balance, or the familiar lordosis seen in the toddler?

At NYU-CPS, we are now in the process of validating a checklist of selected items to be used for the evaluation of juvenile below-knee amputee gait patterns, together with appropriate criteria for the identification of "deviations" at various age levels. If any of the participating clinics have developed a gait evaluation plan at their facilities, we would greatly appreciate hearing from them and learning of their experiences. We hope to provide a procedure - objective, standardized and simple to administer --which will serve to identify abnormalities in the child amputee gait.

Marjorie Agate is with the Child Prosthetic Studies at New York University

References:
Graham, Marshall A. and Kramer, Herbert E., "A Checkout Procedure for Below-Knee Artificial Limbs", Journal of the Association for Physical and Mental Rehabilitation, 10:3:86, May-June, 1956. 
"Gait Analysis", Below-Knee Prosthetics Course, Prosthetic and Orthotic Education, New York University Post-Graduate Medical School (unpublished). 
Kitabayashi, Betty, "The Physical Therapist's Responsibility to the Lower Extremity Child Amputee", The Physical Therapy Review, Vol. 41, No. 10, October, 1961.