Table 4.

Level 4 device-specific physical therapy protocol.

Protocol		Description	Criteria for advancement
Level 4 (sessions 7 and 8)
	Evaluation	Re-evaluation at final session	N/Aa
	Strengthening	N/A	N/A
	Stretching	To be used for cooldown at session completion	Independent in HEPb
	Education	Importance of continuation of HEP	Verbalizes understanding
	Gait training	Promoting gait initiation on prosthesis side with anterior pelvic rotation, manual techniques and verbal cues to promote increased trunk rotation and trunk rotation symmetry, verbal cueing for symmetrical arm swing and trunk rotation (eg, “relax your shoulders”), and resistive gait training with TheraBand and verbal cues for increased step length with the intact limb and relaxed upright posture	Demonstrates ability to trigger power with at least 90% accuracy for powered prosthetic foot and increased gait symmetry for trunk rotation and arm swing, as determined through observational gait analysis
	Mobility training	Ascending and descending ramps and stairs	Stair Assessment Index score of at least 4 (with assistive device, step-to pattern) for ascending and descending stairs, and ambulates in the community without increased participant-reported stumbles or falls compared with baseline
	Neuromuscular reeducation	Applied during HEP	Demonstrates increased gait symmetry for step length, push off, anterior pelvic rotation, upright posture, trunk rotation, and arm swing
	HEP	Review HEP	Demonstrates independence in HEP

^aN/A: not applicable.

^bHEP: home exercise program.