Abstract
Background and Purpose: As of 2005, it is estimated that nearly one in 190 people in the United States were living with the loss of a limb, equaling 1.6 million people. Researchers predict that this number is likely to grow to 3.6 million by the year 2050. There are several functional limitations that correspond with the amputation of the lower extremities, one of the most important functional tasks being gait. Body weight supported treadmill training (BWSTT) has been used with various populations, and studies have demonstrated that improvements in gait found during training translated into improved over ground ambulation and endurance. The purpose of this retrospective case report is to examine the progression of traditional physical therapy interventions following a trans-tibial amputation (TTA) and explore the potential benefits of utilizing BWSTT to improve gait efficiency. Case Description: Patient is a 73-year-old male with the inability to stand and walk following TTA. He was limited by several co-morbidities and an extensive past medical history. His self reported goal was to become independent with household and community ambulation. Initial Examination: Patient demonstrated active range of motion within functional limits for both lower limbs with the exception of knee extension on residual limb. He also presented with decreased strength in hip musculature and safety concerns with transfers. He was unable to don his prosthetic device due to a blister on distal residual limb. Interventions: 10-week plan of care included seated and standing therapeutic exercise, as well as stretching and balance training on various surfaces. The majority of the interventions were focused on gait training with the prosthetic device on indoor and outdoor surfaces. Outcome: The patient improved in strength and overall balance, decreasing risk for falls. The patient was able to ambulate 450 feet over outdoor terrain with the use of a single point cane with fewer gait deviations than at initial presentation. Conclusion: Benefits of traditional physical therapy interventions were demonstrated through follow-up assessment and measured using objective tests. Further improvements in endurance and the need for an assistive device may have been possible by utilizing BWSTT for prolonged ambulation. Although physical therapy intervention correlated with increased patient functioning, causation is hard to fully determine given some limitations of the case report.