Step length symmetry adaptation to split-belt treadmill walking after acquired non-traumatic transtibial amputation.

BACKGROUND

Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. However, individuals with non-traumatic TTA have critical health-related impairments that may influence the ability to respond to split-belt treadmill walking.

RESEARCH QUESTION

Do people with acquired, non-traumatic TTA adapt and retain a more symmetrical gait pattern in response to split-belt treadmill walking?

METHODS

Step length asymmetry was measured during split-belt treadmill walking. Eight participants walked under two alternating belt speed conditions: symmetrical (3 sets; Baseline, TIED1, TIED2) and asymmetrical belt speeds (5 sets; SPLIT1-5). One-way repeated-measures ANOVA with post-hoc Tukey's HSD tests were used to assess adaptation and short-term retention of step length symmetry. Adaptation was assessed as the level of asymmetry during TIED walking following repeated exposure to SPLIT walking. Retention was measured as the change in level of asymmetry during each set of SPLIT walking.

RESULTS

Significant adaptation to split-belt walking was observed from late Baseline to early TIED1 and early TIED2. Between-limb step length asymmetry decreased from late Baseline (5.3 ± 3.4) to early TIED1 (-9.4 ± 3.6) and this change was sustained between early TIED1 and early TIED2 (-11.2 ± 3.1) (ANOVA F = 73.043, p < .001). Adaptations were retained as step length asymmetry decreased from early SPLIT1 (48.5 ± 5.3) to early SPLIT3 (31.4 ± 3.5) to early SPLIT5 (23.9 ± 5.1) (ANOVA F = 35.284, p < .001).

SIGNIFICANCE

Individuals with non-traumatic TTA are capable of gait adaptation to split-belt walking and short-term retention of adaptations after removal of the asymmetrical belt speeds. Adaptability of step length symmetry is possible without modification to the prosthetic limb. Split-belt walking should be tested as a potential intervention to help people with acquired, non-traumatic TTA increase between-limb step symmetry.

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest Research reported in the publication was supported by NIH/NCATS Colorado CTSA [grant number TL1 TR002533 and UL1 TR002535] and the Foundation for Physical Therapy [Promotion of Doctoral Studies II]. The funding sources had no role in the design, execution, analysis, interpretation of the data, writing of the article, or decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the U.S. Department of Veterans Affairs, or the United States Government.