Aided gait of people with lower-limb amputations: comparison of 4-footed and 2-wheeled walkers.

OBJECTIVES: To test the hypotheses that prosthesis-wearing people with lower-limb amputations, using 2-wheeled walkers (TWW) versus 4-footed walkers (FFW), (1) walk faster, (2) walk with fewer interruptions, (3) walk no less safely, and (4) prefer the TWW. DESIGN: Within-subject comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Twenty prosthesis-wearing people with lower-limb amputations (13 men, 7 women) with a mean age +/- standard deviation of 69+/-13 years. Of the subjects, 11 had unilateral transfemoral amputations, 7 had unilateral transtibial amputations, and 2 had bilateral transtibial amputations. INTERVENTION: Participants were trained to use both walkers. MAIN OUTCOME MEASURES: Five-meter walking velocity, gait pattern, need for spotter intervention, foot position with respect to the base of support of the walker, and subject preference. RESULTS: Subjects walked 28.5% faster when using the TWW (P=.000). During gait cycles, 100% of subjects brought the FFW to a complete halt, whereas only 55%, particularly subjects with transfemoral amputations, halted the TWW (P=.008). There was no difference in the need for spotter intervention. Subjects with unilateral amputations placed their feet significantly more anteriorly within the walker base of support when using an FFW (P=.000). Fourteen subjects preferred the TWW, and 6 chose the FFW (not significant). CONCLUSION: The TWW allows prosthesis-wearing people with lower-limb amputations, especially those with transtibial amputations, to walk more quickly and with less interruption, but no less safely, than the FFW. The findings have implications for ambulation training and the prescription of ambulation aids.

Ambulation aid use during the rehabilitation of people with lower limb amputations.

Our objective was to describe the progression of ambulation aid use by people with lower limb amputations during their initial rehabilitation. We prospectively studied 37 people with recent lower limb amputations and a mean (SD) age of 68 (13) years. Subjects were evaluated each weekday during gait-training physiotherapy sessions, and the type and order of ambulation aids used during ambulation training were documented. The total number of gait-training sessions that we observed was 605, with a mean (SD) of 16.4 (7.7) sessions per participant and a range of 5-47. Of the 37 participants, 33 (89%) were discharged with prostheses. The mean (SD) number of aids per person was 2.9 (1.0). The percentage of participants who used each aid (presented in the mean order in which they were first used) were 76% parallel bars, 60% four-footed walkers, 81% two-wheeled walkers, 11% two crutches, 8% four-wheeled walkers, 46% two canes, and 14% one cane. People with lower limb amputations generally use a number of ambulation aids in a fairly consistent order as they progress through their initial rehabilitation. These findings have implications for the process of providing ambulation aids and provide a foundation for further study.