Rehabilitation, Gait Training, and Patient Assessment
Gait cycle
Stance is about 60% and swing about 40% of the cycle. Stance phases: initial contact, loading response, midstance, terminal stance, pre-swing. Swing: initial, mid and terminal.
Measures
- Step length is the distance between successive contacts of opposite feet; stride length is two steps.
- Cadence is steps per minute; walking speed = step length × cadence.
- Comfortable speed is about 1.2 m/s, with cadence around 100–120 steps/min.
Prosthetic deviations
Vaulting, circumduction, lateral trunk bend, excessive knee flexion, foot slap, drop-off and uneven step length. Identify the cause - alignment, length, suspension, pain or weakness - before adjusting.
Assessment
K-levels K0–K4; outcome measures such as the Amputee Mobility Predictor, Timed Up and Go, 6-minute walk test and prosthetic user surveys. Residual limb care includes hygiene, sock management and monitoring volume change.
Worked example
A patient takes 100 steps in one minute with a step length of 0.60 m. Speed = 0.60 × 100 = 60 m/min = 1.0 m/s. If cadence rises to 120 with the same step length, speed becomes 72 m/min. If step length is asymmetric, measure each side separately; a shorter prosthetic step suggests discomfort or poor suspension.
Traps
Confusing step and stride; treating 60% stance as 60% for each limb; changing alignment before checking limb length and suspension; ignoring fear of falling.