Highsmith M Jason, Andrews Casey R, Millman Claire, Fuller Ashley, Kahle Jason T, Klenow Tyler D, Lewis Katherine L, Bradley Rachel C, Orriola John J
School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA.
School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
Technol Innov. 2016 Sep;18(2-3):99-113. doi: 10.21300/18.2-3.2016.99. Epub 2016 Sep 1.
Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked.
使用假肢的下肢截肢患者在行走时存在步态不对称以及肢体负荷和运动策略改变的情况。后续的继发病症被认为与步态偏差有关，并导致长期并发症，进而影响功能和生活质量。本研究的目的是系统回顾文献，以确定支持步态训练干预措施的证据强度，并制定证据声明，以指导与下肢截肢者治疗性步态训练相关的实践和研究。我们对三个数据库进行了系统回顾，随后对证据进行评估并综合实证证据声明（EES）。该综述纳入了18篇手稿，涵盖步态训练干预的两个领域：1）地面行走训练和2）跑步机训练。共综合了8条EES。其中4条涉及地面行走步态训练，1条涵盖跑步机训练，3条声明涉及两种治疗形式。由于下肢截肢导致步态不对称、生物力学改变以及相关的继发后果，因此需要进行步态训练干预并研究其疗效。研究发现，结合言语或其他听觉、手动以及心理意识干预的地面行走训练在改善步态方面是有效的。同样，跑步机训练也被证明是有效的：1）作为地面行走训练的补充；2）在增加视觉反馈和/或体重支持的情况下单独使用；或3）作为家庭锻炼计划的一部分。所研究的步态训练方法改善了步态的多个方面，包括矢状面和冠状面生物力学、时空指标以及行走距离。
