Department of Orthopaedics and Rehabilitation, Center for the Intrepid, Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Phys Ther. 2011 Sep;91(9):1385-94. doi: 10.2522/ptj.20100360. Epub 2011 Jul 14.
Gait training is an important component of rehabilitation after lower-extremity amputation. Abnormal gait performance often persists even for individuals who reacquire a high level of function. This case report describes the use of a virtual reality (VR)-based gait training program that provides real-time feedback in order to improve biomechanical and physiological performance. The aim of this case report is to describe the effects of the training in a person with a transfemoral amputation.
A 24-year-old man with a transfemoral amputation completed a 3-week gait training program. The intervention consisted of 12 sessions of treadmill walking with real-time visual feedback on full-body gait kinematics. A treating therapist directed the patient's attention to specific gait deviations as a means to normalize gait biomechanics.
The patient completed overground biomechanical gait analyses and multiple-speed treadmill tests 3 weeks apart prior to and following the training program. Biomechanical gait analyses indicated the training produced improved frontal-plane hip, pelvis, and trunk motion during overground walking. Improvement in trunk motion was observed at the posttraining test, and improvements in pelvis and hip motion were observed at the 3-week follow-up test. Decreases of up to 23% in oxygen consumption also were demonstrated.
Although the exact contribution of the visual feedback could not be isolated, the training was effective in improving the patient's walking performance. Biomechanical data suggest correcting trunk motion and increasing hip abductor strength (force-generating capacity) may be important in facilitating improvements at the pelvis and hip. Observed improvements in oxygen consumption were significantly larger than achieved through previously reported interventions.
步态训练是下肢截肢后康复的重要组成部分。即使对于那些重新获得高水平功能的个体，异常的步态表现也常常持续存在。本病例报告描述了使用基于虚拟现实（VR）的步态训练程序，该程序可提供实时反馈，以改善生物力学和生理性能。本病例报告的目的是描述该训练在一名股骨截肢患者中的效果。
一名 24 岁男性因股骨截肢完成了为期 3 周的步态训练计划。该干预措施包括 12 次跑步机行走，实时反馈全身步态运动学的视觉反馈。治疗治疗师将患者的注意力集中在特定的步态偏差上，以实现步态生物力学的正常化。
患者在训练计划前后 3 周分别完成了地面生物力学步态分析和多种速度跑步机测试。步态生物力学分析表明，训练可改善地面行走时的额状面髋关节、骨盆和躯干运动。在训练后测试中观察到躯干运动的改善，在 3 周随访测试中观察到骨盆和髋关节运动的改善。耗氧量也降低了高达 23%。
虽然无法孤立地确定视觉反馈的确切贡献，但该训练有效地改善了患者的行走表现。生物力学数据表明，纠正躯干运动和增加髋关节外展肌力量（产生力量的能力）可能对促进骨盆和髋关节的改善很重要。观察到的耗氧量的改善明显大于以前报告的干预措施所取得的改善。
