Underwater Treadmill Training in Adults with a Unilateral Transtibial Amputation

Abstract

ABSTRACT A unilateral transtibial amputation (TTA) propagates secondary physical conditions and complications that may negatively impact quality of life and health. Often, there are challenges to balance, posture, and functional mobility. Underwater treadmill training (UTT) is an alternative modality for people with a TTA that can address these concerns. Series case studies were conducted with three adults (1 female, 2 males) with a TTA to establish the efficacy of UTT within this population and to better understand the challenges to activities of daily living (ADL) and physical activity (PA). Participants completed a 6-week underwater treadmill training protocol and participated in a focus group. Pre-, mid-, and post-UTT measures of balance, fall risk, center of pressure, and weight distribution were assessed. Pre- and post-assessments of walking capacity and balance confidence were also measured and cardiovascular responses to exercise were monitored during the UTT. Outcomes of training increased balance, reduced fall risk, and improved weight distribution from left to right and front to back with increased reliance on the prosthetic limb. Balance confidence during PA and functional mobility improved. Cardiovascular responses and rate of perceived exertion were positive and linearly associated with walking bout time and walking speed, respectively. The focus group revealed themes of a need for increased planning and decreased tolerance when performing ADL. Residual limb symptoms underscored themes of challenges with cardiovascular and resistance training exercises. Participants also noted being more active post-amputation to increase health or physical fitness and attempt to return to pre-amputation levels of PA. Reponses also highlighted themes of improved balance or posture while standing or ambulating and increased confidence while performing activities with a prosthesis following UTT. Improved muscular fitness was also a consistent theme with all improvements resulting in increased exercise tolerance. Overall, UTT was an effective and safe training modality which yielded improvements in physical performance and function for people with a TTA. Participation in UTT can increase physical fitness to minimize objective and subjective challenges associated with completing ADL and being physically active in those with a TTA.