How Too Many Cues Can Make Prosthetic Gait Training Worse
What’s the easiest way to frustrate yourself and your patient when you’re working on prosthetic gait training?
Let me paint a picture: you notice multiple deviations at once, your mind starts flooding with ideas, and you go on a wild goose chase. You want to clean everything up immediately, so you start cueing weight shift over the prosthesis, keep the chest up, swing your arms, take a longer step with the sound side, chew gum, recite the quadratic equation.
Sound familiar? (It’s okay. I still catch myself wanting to fall into this trap.)
It comes from a good place. You’re trying to help.
The problem is that walking isn’t something most people are used to consciously controlling. It’s a highly automatic movement. As soon as we ask someone to think about how they walk, it already starts to feel awkward. When we then layer on multiple cues at once, it becomes even more unnatural.
Instead of improving the pattern, the patient starts to overthink it. The movement becomes rigid and awkward, and sometimes looks more like a zombie trying to walk than the smooth, natural gait pattern we’re envisioning. At that point, they’re no longer walking. They’re trying to manage too many instructions at once.
In most cases, a better approach is to focus on one priority at a time.
Choose the deviation that matters most and direct your attention there. (hint hint Increasing prosthetic side weight shift and stance time is a great place to start!) Give the patient time to work through it, feel it, and begin to develop some consistency before introducing something new. As that change becomes more natural, you can layer in the next piece.
What’s interesting is that when one key issue improves, other aspects of the gait pattern often clean up with it. You don’t always need to chase every deviation individually.
In this instance, more does not mean better. More cues usually create more confusion.
Clear priorities, a focused approach, and a bit of patience tend to go much further.