# Optimizing Gait Rehabilitation for Veterans with Non-Traumatic Lower Limb Amputation

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2020 · —

## Abstract

The focus of this study is to improve walking symmetry in order to optimize walking ability and reduce disability
for Veterans with non-traumatic lower limb amputation (LLA). Over 80% of current LLAs are non-traumatic,
resulting from complications of pathologies, such as diabetes mellitus and peripheral artery disease. Despite
current declines in total amputation rate among Veterans, the population with non-traumatic LLA is growing.
For example, from 2000 to 2004 the relative amputation rate decreased by 34%. However, due to an increase
in the number of Veterans with diabetes during the same period, the population of Veterans with diabetes and
initial LLA increased by 23%. Following LLA, excessive gait asymmetry is common. Asymmetric gait
characteristics are of critical importance as excessive asymmetry may increase the severity of disability
experienced by people with non-traumatic LLA and contribute to secondary pain conditions (low back pain and
osteoarthritis), poor gait efficiency, declines in physical performance, and compromised skin integrity of the
residual limb. Compared to individuals with traumatic LLA, the poor gait performance of those with non-
traumatic LLA is further compounded by older age, lower premorbid function, presence of comorbidities,
frequent wound development, and delayed healing in the residual limb. While improving gait symmetry is a
goal of conventional prosthetic rehabilitation, persistence of gait asymmetry for years after LLA highlights the
ineffectiveness of current rehabilitation practices in achieving this goal. As a means of improving gait
symmetry, this study aims to determine the efficacy of error-manipulation gait training using two approaches
(error-augmentation and error-correction) compared to current standard-of-care in a three-arm randomized
controlled trial. Error-manipulation gait training intervention will be delivered in eight training sessions (2x/week,
4 weeks) with 54 Veterans (18 per intervention group, 18 in control group) who have non-traumatic, unilateral,
transtibial LLA. It is unclear which, if either, form of error-manipulation gait training is efficacious for improving
persistent gait symmetry in Veterans with non-traumatic LLA. Error-augmentation gait training is a promising
and novel intervention that involves exaggerating an existing movement error to force the neuromuscular
system to correct the error. While this form of gait training improved gait symmetry in small studies of
individuals with chronic stroke or traumatic amputation, it has yet to be evaluated in older Veterans with non-
traumatic LLA. In contrast, error-correction training involves reducing movement errors by overcorrecting for
asymmetry. Both error-augmentation and error-correction gait training are based upon motor learning
principles of distributed practice, task specificity, and feedback. Each of these error-manipulation interventions
have potential advantages over traditional gait training following LLA which i...

## Key facts

- **NIH application ID:** 10049200
- **Project number:** 5I01RX003237-02
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Cory L Christiansen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-11-01 → 2023-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10049200

## Citation

> US National Institutes of Health, RePORTER application 10049200, Optimizing Gait Rehabilitation for Veterans with Non-Traumatic Lower Limb Amputation (5I01RX003237-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10049200. Licensed CC0.

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