Walking and balance in children and adolescents with lower-limb amputation: A review of literature.

BACKGROUND: Children with lower limb loss face gait and balance limitations. Prosthetic rehabilitation is thus aimed at improving functional capacity and mobility throughout the developmental phases of the child amputee. This review of literature was conducted to determine the characteristics of prosthetic gait and balance among children and adolescents with lower-limb amputation or other limb loss. METHODS: Both qualitative and quantitative studies were included in this review and data were organized by amputation etiology, age range and level of amputation. FINDINGS: The findings indicated that the structural differences between children with lower-limb amputations and typically developing children lead to functional differences. Significant differences with respect to typically developing children were found in spatiotemporal, kinematic, and kinematic parameters and ground-reaction forces. Children with transtibial amputation place significantly larger load on their intact leg compared to the prosthetic leg during balance tasks. In more complex dynamic balance tests, they generally score lower than their typically developing peers. INTERPRETATION: There is limited literature pertaining to improving physical therapy protocols, especially for different age groups, targeting gait and balance enhancements. Understanding gait and balance patterns of children with lower-limb amputation will benefit the design of prosthetic components and mobility rehabilitation protocols that improve long-term outcomes through adulthood.

The Effects of Walking Surface on the Gait Pattern of Children With Idiopathic Toe Walking.

Idiopathic toe walking treatments are not conclusively effective. This study investigated the effects of walking surface on gait parameters in children with idiopathic toe walking. Fifteen children with idiopathic toe walking and 15 typically developing children aged 4 to 10 years completed the study, which included a barefoot gait exam over three 4-m walkways. Each of the walkways was covered with a different surface: vinyl tile, carpet, and pea gravel. Temporal-spatial parameters were recorded along with a measure of early heel rise (HR32). Children with idiopathic toe walking and typically developing children shared similarly changed gait patterns on each surfaces. Only HR32 was significantly different between the groups (P < .001). Children with idiopathic toe walking showed significantly less toe-walking on the gravel walkway (P < .001). Walking surface plays a significant role in altering gait patterns in both children with idiopathic toe walking and typically developing children. Walking on a gravel surface should be further explored for idiopathic toe walking.