Prosthetic Gait Training for Lower Extremity Amputees.

Gailey RS, Gailey AM. Miami, FL 33173, Advanced Rehabilitation Therapy Inc, 1992, VHS, 56 Min, $75.

Robert and Ann Gailey have written, directed, and produced an excellent sequence of exercises and activities to benefit the patient with unilateral amputation. The videotape consists of four parts and begins with a brief strengthening program. Robert Gailey, who is on the faculty of the University of Miami, guides a young woman who has an above-knee amputation through seven basic exercises that were described as dynamic exercises by Eisert and Tester in 1954. In the videotape, the patient wears a prosthesis with an endoskeletal shank and a distal thigh with a cosmetic foam cover, that makes the prosthetic side almost indistinguishable from the sound limb. The only equipment needed for the exercises are a towel roll and a stool. Each exercise, hip extension, hip adduction, hip flexion, back extension, hip adduction, bridging, and sit-ups, is related to a specific phase of gait. Gailey advocates the "rule of 10," a 10-second contraction, followed by a 10-second rest, for 10 repetitions.

Part 2 is a 9-minute summary of the pre-gait training exercise program. The split-screen technique allows the viewer to see the patient and therapist in simultaneous frontal and sagittal views. Gailey presents the image of the patient's center of gravity as a blue marble in the center of the pelvis that must be kept within the base of support. Standing within parallel bars, the patient shifts laterally, anteroposteriorly, and diagonally, responding to the therapist's manual and verbal cues. Gailey also mentions challenging activities, such as using a ball and stepping on a footstool. The goals of the pre-gait training program are to control hip musculature on the amputated side, become comfortable with the sensation of the socket, and become aware of the prosthetic foot.

The third part is on gait training protocol and is 17 minutes long. While maintaining a walking base of 2 to 4 in between the heel centers, the patient steps forward with the sound limb, moving the pelvis forward, then steps with the prosthesis. She avoids circumduction and abduction. She then steps backward and varies the step length, emphasizing pelvic motion. Resistive gait training involves splinter skills, so that the patient can focus on the feeling, rather than the mechanics, of motion. Side stepping demands gluteus medius muscle control, with the therapist applying resistance. The patient learns to rotate her upper and lower torso, aided by exaggerated head turning. Outside the parallel bars, ambulation training focuses on shoulder motion.

"Advanced Balance Training Skills," part 4, is the longest portion of the production--29 minutes. The patient performs tandem walking, which is walking in a straight line with one foot in front of the other. She also executes side stepping and cariocas, crossing the sound limb over the prosthesis in a straight line, then reversing the sequence. Close-quarter turns and following the therapist who demonstrates random forward, side, and backward turning refines the patient's control of the prosthesis.

Gailey and Gailey are to be commended for presenting such a clear sequence of preprosthetic and prosthetic training activities. The exercises are appropriate for patients with below-knee or above-knee amputation and can be attempted by those with bilateral amputation. Although most individuals with amputation are considerably older than the young adult who performs the exercises, the videotape can orient the geriatric patient if the physical therapist using the tape provides a few words of explanation to bridge the age span. The experienced physical therapist will recognize many other activities that can be included in the preprosthetic and prosthetic training programs, such as strengthening exercises utilizing various apparatus and training in transfers, both with and without the prosthesis, as well as engaging in athletic skills and maneuvering on stairs, curbs, and ramps. Nevertheless, this videotape is a fine introduction suited to physical therapists, patients, and family members.