Use of quantitative gait analysis for the evaluation of prosthetic walking performance

Prosthetists must be skilled in observational gait analysis to perform a rapid assessment of their client's gait in the clinic and make appropriate adjustments to the prosthesis to eliminate or reduce gait abnormalities. Quantitative gait evaluations are able to provide additional, objective information to supplement the clinical observation. Although quantitative gait analysis has become a clinically accepted means for evaluating and documenting certain pathologies that affect pediatric gait such as cerebral palsy and myelomeningocele, routine clinical quantitative gait analyses are not performed on lower-limb prosthesis users. Unfortunately, limitations in our understanding about the pathomechanics of amputee gait and the functions that need to be provided by prostheses inhibit our ability to effectively use quantitative gait data as a means to diagnose and treat observed gait deviations. Furthermore, data pertaining to amputee gait can be difficult to assess and interpret because the data can be highly influenced by the particular choice of prosthetic components, socket type, and suspension, as well as by the residual anatomy, abilities, and psychological well-being of the patient. Studies of prosthetic users reported in the literature tend to indicate a lack of consistency in quantitative gait measures, even in similar populations of amputee subjects who are walking with comparable prosthetic configurations. Therefore, the value of using these data individually for outcome measures is questionable. At present, quantitative gait analysis appears to be beneficial for documenting the rehabilitation progress of patients over time and may be useful for evaluating some prosthetic gaits, but the information may not necessarily enable the experienced clinician to make better decisions regarding prosthetic prescription or modifications. Nonetheless, it is important that we continue to strive to effectively integrate these quantitative measurements with the experience and skill of the prosthetist and the subjective feedback of the prosthetic user.