Gait Training For Children With Temporary Lower-Extremity Prostheses
Grace C. Horton
Although the temporary lower-extremity prosthesis for juvenile amputees was originally used as a "stump shrinker", it also provides a means by which the child can develop a good prosthetic gait pattern with a minimal amount of close supervision and instruction.
Prior to the use of the temporary lower-extremity prosthesis, the gait and functional training given by the physical therapy department was concentrated within a one to three week period, while the child and parents boarded in the community or the child was hospitalized. During this period the physical therapist taught and supervised the juvenile amputee in balance, posture, coordination and prosthetic control exercises suitable for his age and type of amputation. The child would also practice walking under the supervision and guidance of the physical therapist. In the initial phase of this prosthetic training, an adjustable leg was worn until optimal alignment was obtained. When the permanent prosthesis was fabricated the parents were instructed in its care and given specific exercises for their child to practice at set periods each day. They were also instructed in the observation of gait and the correction of faults to which the particular child might be prone. With the advent of the temporary lower-extremity prosthesis, those intensive pre- and post-prosthetic training periods have been reduced considerably.
Training Schedule Revised
When the juvenile amputee is fitted with his temporary prosthesis, the physical therapist instructs him and his parents in a program of basic balance, postural correction, and prosthetic control exercises to be practiced daily at home under parental supervision. In addition, the progression of the child's preprosthetic strengthening and stretching exercises is continued. If necessary, instructions in a correct gait pattern using crutches or other external support are given to the child and his parents.
In areas where public health physical therapists or local physical therapy clinics are available, the juvenile amputee is referred for follow up and is seen on a weekly basis through these services. Otherwise, he is followed weekly in our physical therapy department at the Medical Center. In this manner, the juvenile amputee's exercise and gait program progresses until a desirable gait is achieved and the maximum functional level is reached. At these visits the physical therapist can instruct the parents in such matters as the use of additional stump socks to compensate for shrinkage and can, if necessary, recommend return visits to the prosthetist for adjustments to the temporary prosthesis. In addition, the child amputee and his parents make regularly scheduled return visits to the amputee clinic. The progress of the treatment program is checked and decisions concerning modifications to the prosthesis or the total program are made by the clinic team.
Faster Adaptation Achieved
After the permanent prosthesis has been prescribed and fabricated, the final development of an efficient and safe prosthetic gait for the child amputee requires only one or two physical therapy visits. Using the temporary prosthesis the juvenile lower-extremity amputee reaches the maximum potential of stump shrinkage and muscle development; and attains a suitable gait pattern in considerably less time than was previously the case. In addition the child's parents assume an active role in the training program and the child remains a part of the home and local community while learning to use his prosthesis.
Clippinger, F. W. and Titus, B.: "The Temporary Lower-Extremity Prosthesis", Inter-Clinic Information Bulletin, Volume TV, Number 10, August 1965.
Grace C. Horton is the Clinical Supervisor and Associate in Physical Therapy Duke University Medical Center Durham, North Carolina