Posted by vanessa on April 26, 2018
Students from the Columbia University DPT class of 2018, and Dr. Christopher Kevin Wong, PT, PhD, have published a narrative review of physical therapy approaches to balance and gait training in people with lower limb loss. One finding that stands out is the paucity of randomized controlled studies that included more than 40 subjects.
The strongest evidence was for unstable surface balance training and gait training programs that included strength, coordination, and functional training. However, the evidence suggests that a range of methods including manual therapy to the hip and lumbopelvic region, core stabilization exercises, and resisted gait training have positive effects.
In the narrative review, the authors provide clinical suggestions that address all domains of the International Classification of Functioning (ICF) in a logical sequence with the acronym PANACEA: Passive structures, such as joints; Active functions, such as muscle strength; Neuromotor function, such as coordinated movement patterns; Awareness of those motions, so that the person can practice and monitor themselves; Capacity for function, such as the cardiopulmonary capacity for sufficient performance and the cognitive capacity to understand; Environment specific training, so that training can translate to community life; And, Action to be taken by the individual, which involves their motivation and other factors. You may access the article via the link here.
Wong CK, Sheppard JK, Williams KL. Balance and gait training to community-dwelling people with lower limb loss: a narrative review with clinical suggestions. Phys Ther Rvw, 2018;23: Epub April 4, 2018.
Dr. Christopher Kevin Wong (right) working with a patient