Kinematic and kinetic gait analysis in the sagittal plane of trans-femoral amputees before and after special gait re-education.

A special gait-training programme, combining a psychological therapeutic approach with methods in physiotherapy and body awareness, was used to re-educate nine unilateral trans-femoral amputees. All were rehabilitated trauma or tumour amputees with an age of 16-60 years. They had worn prostheses for more than 18 months. The re-education aimed at integrating the prosthesis in normal movements and increasing body awareness. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system. Results showed almost normalised gait speed and increased symmetry in the hip joints with increased muscle work on the amputated side both immediately and at follow-up. At follow-up there were significant differences in almost all parameters between the two legs of the subjects and when compared to a reference group of 18 healthy volunteers of similar age. Thus, the intact leg compensates for loss of function in the amputated leg and thereby works differently compared to the reference group. For example, during shock absorption the extension moment in the intact knee increased from 0.6 Nm/kg before to 1.0 Nm/kg after treatment and at follow-up compared to 0.4 Nm/kg in the reference group. The eccentric power of quadriceps increased from 0.6 w/kg before to 1.8 w/kg after treatment and 1.7 w/kg at follow-up compared to 0.4 w/kg in the reference group. The limp of amputees is usually observed in the frontal plane, but the authors' special focus on the sagittal plane here illustrates gait propulsion influences. The positive training results remained after six months.