Singapore has one of the highest rates of lower extremity amputations in the world, with hospitals performing close to 4 amputations per day. Rehabilitation is usually a requirement to mitigate impairments. However, one of the most time consuming aspects of rehabilitation involves gait training. Part of the challenge comes from the lack of normative gait parameters specific to the local population to guide therapy sessions. This may in turn result in variable rehabilitation outcomes.

The challenge

The process of amputee rehabilitation is best realised in an interdisciplinary team setting. One of the main goals would be to restore function and quality of life. Post amputation, patients are assessed and commenced on prosthetic gait training when suitable to do so and this usually starts with standing exercises eventually leading to basic and more advanced walking exercises under supervision of a trained physiotherapist. This process while guided by broad principles in amputee rehabilitation still relies to some extent on the experience of the physiotherapist, along with the support of the other members of the interdisciplinary team. The physiotherapist needs to assess initial gait and then later to see if gait with the prosthesis is safe and appropriate. Often, assessment means is via clinical judgement and there are no gait parameters recorded, partly because intention is for functional training.

With the usage of wearable inertial sensors and pressure mapping insoles, this process could potentially be optimised by the identification of abnormal pressure distribution, aberrant gait patterns and aid the physiotherapist in deciding upon further rehabilitation strategies. This could then translate into fewer sessions of rehabilitation or improved gait parameters after few sessions of therapy.

The solution

Traditionally, amputee gait rehabilitation requires a specially trained team and has depended very much on the experience of the rehabilitation team and subjective assessment of gait during the training session.

While this approach is effective, it is heavily dependent on the experience of the therapy team.

Given the advances in wearable sensor technology, the study team hopes to outfit amputees with wearable sensors to measure their gait in a process of data-driven rehabilitation. We will use inertial sensors and pressure mapping insoles to measure both the kinematics and dynamics of the amputee gait, and compare them to the normative values in the population. Thus, we hope to generate more accurate and objective feedback during gait training, create a set of normative parameters for gait in prosthetic users and in so doing optimize the gait training component of amputee rehabilitation.

By providing objective data on gait kinematics and parameters through the usage of sensors applied to both normal and prosthetic limbs, this could firstly aid the rehab team and result in shorter rehab duration and lesser adjustments required to the prosthetic limb.

Secondly, the potential for general rehab teams to utilize such a system to guide therapy even in non-amputee rehab focussed centers is possible.

Such systems have not been widely implemented in rehabilitation centers worldwide and if shown to be effective and feasible would mark a significant step forward in amputee gait training.