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Choi HJ, Choi J, Kim GS, Sung Kim H, Ko CY. Asymmetry of peak plantar pressure in transfemoral amputees during indoor and outdoor walking. J Biomech 2024; 170:112177. [PMID: 38838496 DOI: 10.1016/j.jbiomech.2024.112177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
This study investigates the differences in peak plantar pressure between the amputated and intact limbs of transfemoral amputees when walking outdoors. Ten non-amputees (aged 24.4 ± 2.0 years, 176.9 ± 2.5 cm, 72.3 ± 7.9 kg) and six transfemoral amputees (48.5 ± 6.3 years, 173.8 ± 4.2 cm, 82.0 ± 11.9 kg) participated in the study. Over approximately 1.6 km, the participants encountered various obstacles, including stairs, uneven surfaces, hills, and level ground, both indoors and outdoors. Throughout the walking session, the peak plantar pressure in both feet was monitored using wearable insole sensors. For all terrains, the percentage asymmetry was determined. Significant changes in peak plantar pressure asymmetry were found between the intact and amputated limbs, particularly when walking on level ground indoors, uneven terrains, descending stairs, and on steep slopes outdoors (all p < 0.05). These findings highlight the greater peak plantar pressure asymmetry in transfemoral amputees when walking outside. In addition, this study revealed that not all terrains contribute uniformly to this asymmetry.
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Affiliation(s)
- Hyuk-Jae Choi
- Rehabilitation Engineering Research Institute, Incheon, Republic of Korea.
| | - Junwon Choi
- Department of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea.
| | - Gyoo-Suk Kim
- Rehabilitation Engineering Research Institute, Incheon, Republic of Korea.
| | - Han Sung Kim
- Department of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea.
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He Y, Hu M, Jor A, Hobara H, Gao F, Kobayashi T. Dynamics of Center of Pressure Trajectory in Gait: Unilateral Transfemoral Amputees Versus Non-Disabled Individuals. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1416-1425. [PMID: 38517721 DOI: 10.1109/tnsre.2024.3381046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The primary goal of rehabilitation for individuals with lower limb amputation, particularly those with unilateral transfemoral amputation (uTFA), is to restore their ability to walk independently. Effective control of the center of pressure (COP) during gait is vital for maintaining balance and stability, yet it poses a significant challenge for individuals with uTFA. This study aims to study the COP during gait in individuals with uTFA and elucidate their unique compensatory strategies. This study involved 12 uTFA participants and age-matched non-disabled controls, with gait and COP trajectory data collected using an instrumented treadmill. Gait and COP parameters between the control limb (CL), prosthetic limb (PL), and intact limb (IL) were compared. Notably, the mediolateral displacement of COP in PL exhibited significant lateral displacement compared to the CL from 30% to 60% of the stance. In 20% to 45% of the stance, the COP forward speed of PL was significantly higher than that of the IL. Furthermore, during the initial 20% of the stance, the vertical ground reaction force of PL was significantly lower than that of IL. Additionally, individuals with uTFA exhibited a distinct gait pattern with altered duration of loading response, single limb support, pre-swing and swing phases, and step time. These findings indicate the adaptability of individuals with uTFA in weight transfer, balance control, and pressure distribution on gait stability. In conclusion, this study provides valuable insights into the unique gait dynamics and balance strategies of uTFA patients, highlighting the importance of optimizing prosthetic design, alignment procedures, and rehabilitation programs to enhance gait patterns and reduce the risk of injuries due to compensatory movements.
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3
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Kobayashi T, Jor A, He Y, Hu M, Koh MWP, Hisano G, Hara T, Hobara H. Transfemoral prosthetic simulators versus amputees: ground reaction forces and spatio-temporal parameters in gait. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231854. [PMID: 38545618 PMCID: PMC10966393 DOI: 10.1098/rsos.231854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
This study aimed to compare the ground reaction forces (GRFs) and spatio-temporal parameters as well as their asymmetry ratios in gait between individuals wearing a transfemoral prosthetic simulator (TFSim) and individuals with unilateral transfemoral amputation (TFAmp) across a range of walking speeds (2.0-5.5 km h-1). The study recruited 10 non-disabled individuals using TFSim and 10 individuals with unilateral TFAmp using a transfemoral prosthesis. Data were collected using an instrumented treadmill with built-in force plates, and subsequently, the GRFs and spatio-temporal parameters, as well as their asymmetry ratios, were analysed. When comparing the TFSim and TFAmp groups, no significant differences were found among the gait parameters and asymmetry ratios of all tested metrics except the vertical GRFs. The TFSim may not realistically reproduce the vertical GRFs during the weight acceptance and push-off phases. The structural and functional variations in prosthetic limbs and components between the TFSim and TFAmp groups may be primary contributors to the difference in the vertical GRFs. These results suggest that TFSim might be able to emulate the gait of individuals with TFAmp regarding the majority of spatio-temporal and GRF parameters. However, the vertical GRFs of TFSim should be interpreted with caution.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
- Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Yufan He
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Mark W. P. Koh
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Genki Hisano
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
- Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Takeshi Hara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
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4
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Roda GF, Stoneback JW, Gimarc D, Gaffney BMM. Above knee socket prosthesis use changes proximal femur morphology. Bone 2023; 172:116752. [PMID: 37004980 PMCID: PMC10198956 DOI: 10.1016/j.bone.2023.116752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
Patients with transfemoral amputation (TFA) are up to six times more likely to develop hip osteoarthritis (OA) in either or both the intact and residual limb, which is primarily attributed to habitually altered joint loading due to compensatory movement patterns. However, joint loading patterns differ between limbs, which confounds the understanding of loading-induced OA etiology across limbs. It remains unknown if altered loading due to amputation results in bony shape changes at the hip, which is a known etiological factor in the development of hip OA. Retrospective computed tomography images were collected of the residual limb for 31 patients with unilateral TFA (13F/18M; age: 51.7 ± 9.9 y/o; time since amputation: 13.7 ± 12.4 years) and proximal femur for a control group of 29 patients (13F/16M; age: 42.0 ± 12.27 years) and used to create 3D geometries of the proximal femur. Femoral 3D geometric variation was quantified using statistical shape modeling (SSM), a computational tool which placed 2048 corresponding particles on each geometry. Independent modes of variation were created using principal component analysis. 2D radiographic measures of the proximal femur, including common measures such as α-angle, head neck offset, and neck shaft angle, were quantified on digitally reconstructed radiographs (DRRs). SSM results were then compared to 2D measures using Pearson correlation coefficients (r). Two-sample t-tests were used to determine if there were significant differences between the TFA and control group means of 2D radiographic measurements (p < 0.05). Patients with TFA had greater femoral head asphericity within the SSM, which was moderately correlated to head-neck offset (r = -0.54) and α-angle (r = 0.63), as well as greater trochanteric torsion, which was strongly correlated to the novel radiographic measure of trochanteric torsion (r = -0.78), compared to controls. For 2D measures, the neck-shaft angle was smaller in the TFA group compared to the control group (p = 0.01) while greater trochanter height was larger in the TFA group compared to the control group (p = 0.04). These results indicate altered loading from transfemoral prosthesis use changes proximal femur bony morphology, including femoral head asphericity and greater trochanter changes. Greater trochanter morphologic changes, though not a known factor to OA, affect moment arm and line of action of the primary hip abductors, the major muscles which contribute to joint loading and hip stability. Thus, chronic altered loading of the amputated limb hip, whether under- or overloading, results in bony changes to the proximal femur which may contribute to the etiological progression and development of OA.
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Affiliation(s)
- Galen F Roda
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - David Gimarc
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
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5
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Vandenberg NW, Stoneback JW, Davis-Wilson H, Christiansen CL, Awad ME, Melton DH, Gaffney BMM. Unilateral transfemoral osseointegrated prostheses improve joint loading during walking. J Biomech 2023; 155:111658. [PMID: 37276681 PMCID: PMC10330663 DOI: 10.1016/j.jbiomech.2023.111658] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.
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Affiliation(s)
- Nicholas W Vandenberg
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Hope Davis-Wilson
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cory L Christiansen
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mohamed E Awad
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Danielle H Melton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States; Center for Bioengineering, University of Colorado Denver, Aurora, CO, United States.
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6
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McCain EM, Dalman MJ, Berno ME, Libera TL, Lewek MD, Sawicki GS, Saul KR. The influence of induced gait asymmetry on joint reaction forces. J Biomech 2023; 153:111581. [PMID: 37141689 PMCID: PMC10424665 DOI: 10.1016/j.jbiomech.2023.111581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
Chronic injury- or disease-induced joint impairments result in asymmetric gait deviations that may precipitate changes in joint loading associated with pain and osteoarthritis. Understanding the impact of gait deviations on joint reaction forces (JRFs) is challenging because of concurrent neurological and/or anatomical changes and because measuring JRFs requires medically invasive instrumented implants. Instead, we investigated the impact of joint motion limitations and induced asymmetry on JRFs by simulating data recorded as 8 unimpaired participants walked with bracing to unilaterally and bilaterally restrict ankle, knee, and simultaneous ankle + knee motion. Personalized models, calculated kinematics, and ground reaction forces (GRFs) were input into a computed muscle control tool to determine lower limb JRFs and simulated muscle activations guided by electromyography-driven timing constraints. Unilateral knee restriction increased GRF peak and loading rate ipsilaterally but peak values decreased contralaterally when compared to walking without joint restriction. GRF peak and loading rate increased with bilateral restriction compared to the contralateral limb of unilaterally restricted conditions. Despite changes in GRFs, JRFs were relatively unchanged due to reduced muscle forces during loading response. Thus, while joint restriction results in increased limb loading, reductions in muscle forces counteract changes in limb loading such that JRFs were relatively unchanged.
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Affiliation(s)
| | | | | | - Theresa L Libera
- North Carolina State University, Raleigh, NC, USA; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Michael D Lewek
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Di Paolo S, Barone G, Alesi D, Mirulla AI, Gruppioni E, Zaffagnini S, Bragonzoni L. Longitudinal Gait Analysis of a Transfemoral Amputee Patient: Single-Case Report from Socket-Type to Osseointegrated Prosthesis. SENSORS (BASEL, SWITZERLAND) 2023; 23:4037. [PMID: 37112378 PMCID: PMC10143735 DOI: 10.3390/s23084037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
The aim of the present case report was to provide a longitudinal functional assessment of a patient with transfemoral amputation from the preoperative status with socket-type prosthesis to one year after the osseointegration surgery. A 44 years-old male patient was scheduled for osseointegration surgery 17 years after transfemoral amputation. Gait analysis was performed through 15 wearable inertial sensors (MTw Awinda, Xsens) before surgery (patient wearing his standard socket-type prosthesis) and at 3-, 6-, and 12-month follow-ups after osseointegration. ANOVA in Statistical Parametric Mapping was used to assess the changes in amputee and sound limb hip and pelvis kinematics. The gait symmetry index progressively improved from the pre-op with socket-type (1.14) to the last follow-up (1.04). Step width after osseointegration surgery was half of the pre-op. Hip flexion-extension range significantly improved at follow-ups while frontal and transverse plane rotations decreased (p < 0.001). Pelvis anteversion, obliquity, and rotation also decreased over time (p < 0.001). Spatiotemporal and gait kinematics improved after osseointegration surgery. One year after surgery, symmetry indices were close to non-pathological gait and gait compensation was sensibly decreased. From a functional point of view, osseointegration surgery could be a valid solution in patients with transfemoral amputation facing issues with traditional socket-type prosthesis.
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Agostino Igor Mirulla
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
- Department of Engineering, University of Palermo, 40126 Palermo, Italy
| | - Emanuele Gruppioni
- Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Centro Protesi Inail, 40054 Vigorso di Budrio, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
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Sonoda Y, Maeshige N, Uemura M, Imaoka S, Kawabe N, Hayashi H, Fujii M, Tsuji Y, Furukawa M, Kohzuki M, Terashi H. Effect of Partial Foot Amputation Level on Gait Independence in Patients With Chronic Lower Extremity Wounds: A Retrospective Analysis of a Japanese Multicenter Database. INT J LOW EXTR WOUND 2023:15347346231158864. [PMID: 36814399 DOI: 10.1177/15347346231158864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Partial foot amputation (PFA) is generally planned to minimize the amputation level; nonetheless, the effect of PFA levels on gait independence in amputees remains unclear. This study aimed to investigate the impact of PFA levels of the forefoot on gait independence in patients with chronic lower extremity (LE) wounds. This multicenter retrospective cohort study included 232 hospitalized Japanese patients treated and rehabilitated for chronic LE wounds. A multivariate analysis based on PFA levels was conducted for gait independence at discharge, with age and comorbidities as independent variables. Patients with Lisfranc amputation had significantly less independent gait than patients with more distal amputation and those without amputation (<22% vs >40%; P = .027; Fisher's exact test). Logistic regression analysis revealed that Lisfranc amputation (odds ratio [OR]: 0.257, P = .047), age (OR: 0.559, P = .043), and chronic limb-threatening ischemia (OR: 0.450, P = .010) were independent factors associated with gait independence. Additionally, the regression model confirmed discrimination performance using the C index (0.691, P < .001) with receiver operating characteristic analysis. In patients with chronic LE wounds undergoing PFA, Lisfranc amputation was negatively associated with gait independence.
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Affiliation(s)
- Yuma Sonoda
- Advanced Research Center for Well-being, 12885Kobe University, Kobe, Hyogo, Japan
| | - Noriaki Maeshige
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Mikiko Uemura
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
- 38082Faculty of Health Science, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Shinsuke Imaoka
- 38411Department of Rehabilitation, Oita Oka Hospital, Oita, Oita, Japan
| | - Nobuhide Kawabe
- 13101Faculty of Makuhari Human Care, Tohto University, Makuhari, Chiba, Japan
| | - Hisae Hayashi
- 38291Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoriko Tsuji
- Unit of Podiatric Medicine, 38303Kobe University Graduate School of Medicine, Department of Plastic Surgery, Kobe, Hyogo, Japan
| | | | - Masahiro Kohzuki
- 13302Department of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Yamagata, Japan
| | - Hiroto Terashi
- 38303Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Kobayashi T, Koh MWP, Jor A, Hisano G, Murata H, Ichimura D, Hobara H. Ground reaction forces during double limb stances while walking in individuals with unilateral transfemoral amputation. Front Bioeng Biotechnol 2023; 10:1041060. [PMID: 36727041 PMCID: PMC9885323 DOI: 10.3389/fbioe.2022.1041060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
The asymmetrical gait of individuals with unilateral transfemoral amputation has been well documented. However, there is not a wealth of investigation into asymmetries during the double limb stance depending on whether the intact or prosthetic limb is leading. The first aim of this study was to compare ground reaction forces during the double limb stance of individuals with unilateral transfemoral amputation depending on whether their intact (initial double limb stance) or prosthetic (terminal double limb stance) limb was leading. The second aim of this study was to compare the asymmetry ratio of ground reaction forces during the double limb stance between individuals with and without unilateral transfemoral amputation. Thirty individuals, fifteen with unilateral transfemoral amputation and fifteen who were able-bodied, were recruited for this study. Each individual walked on an instrumented treadmill for 30 s at eight different speeds, ranging from 2.0 km/h to 5.5 km/h with .5 km/h increments. Ground reaction force parameters, temporal parameters, and asymmetry ratios of all parameters were computed from the data collected. The appropriate statistical analyses of all data based on normality were conducted to investigate the aims of this study. Significant main effects of speed, double limb stance, and their interactions were found for most parameters (p < .01 or p < .05). Individuals with unilateral transfemoral amputation spent a longer duration in terminal double limb stance than initial double limb stance at all tested speeds. They also experienced significantly higher peak vertical ground reaction force during initial double limb stance compared to terminal double limb stance with increasing walking speed. However, during terminal double limb stance, higher anteroposterior ground reaction force at initial contact was found when compared to initial double limb stance. Significant differences between individuals with unilateral transfemoral amputation and able-bodied individuals were found in asymmetry ratios for peak vertical ground reaction force, anteroposterior ground reaction force, anteroposterior shear, and mediolateral shear at all tested speeds. Asymmetrical loading persists in individuals with unilateral transfemoral amputation during double limb stance. Increasing walking speed increased ground reaction force loading asymmetries, which may make individuals with unilateral transfemoral amputation more susceptible to knee osteoarthritis or other musculoskeletal disorders. Further study is necessary to develop ideal gait strategies for the minimization of gait asymmetry in individuals with unilateral transfemoral amputation.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mark W. P. Koh
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China,Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Genki Hisano
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan,Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo, Japan,Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Hiroto Murata
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan,*Correspondence: Hiroaki Hobara,
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10
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Liang W, Qian Z, Chen W, Song H, Cao Y, Wei G, Ren L, Wang K, Ren L. Mechanisms and component design of prosthetic knees: A review from a biomechanical function perspective. Front Bioeng Biotechnol 2022; 10:950110. [PMID: 36185421 PMCID: PMC9521192 DOI: 10.3389/fbioe.2022.950110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Prosthetic knees are state-of-the-art medical devices that use mechanical mechanisms and components to simulate the normal biological knee function for individuals with transfemoral amputation. A large variety of complicated mechanical mechanisms and components have been employed; however, they lack clear relevance to the walking biomechanics of users in the design process. This article aims to bridge this knowledge gap by providing a review of prosthetic knees from a biomechanical perspective and includes stance stability, early-stance flexion and swing resistance, which directly relate the mechanical mechanisms to the perceived walking performance, i.e., fall avoidance, shock absorption, and gait symmetry. The prescription criteria and selection of prosthetic knees depend on the interaction between the user and prosthesis, which includes five functional levels from K0 to K4. Misunderstood functions and the improper adjustment of knee prostheses may lead to reduced stability, restricted stance flexion, and unnatural gait for users. Our review identifies current commercial and recent studied prosthetic knees to provide a new paradigm for prosthetic knee analysis and facilitates the standardization and optimization of prosthetic knee design. This may also enable the design of functional mechanisms and components tailored to regaining lost functions of a specific person, hence providing individualized product design.
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Affiliation(s)
- Wei Liang
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
| | - Wei Chen
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
| | - Hounan Song
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
| | - Yu Cao
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
| | - Guowu Wei
- School of Science, Engineering and Environment, University of Salford, Salford, United Kingdom
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, United Kingdom
- *Correspondence: Lei Ren, ; Kunyang Wang,
| | - Kunyang Wang
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
- *Correspondence: Lei Ren, ; Kunyang Wang,
| | - Luquan Ren
- Key Laboratory of Bionic Engineering, Jilin University, Ministry of Education, Changchun, China
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11
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Schmid-Zalaudek K, Fischer T, Száva Z, Lackner HK, Kropiunig U, Bittner C, Höcker K, Winkler G, Peternell G. Kinetic Gait Parameters in Unilateral Lower Limb Amputations and Normal Gait in Able-Bodied: Reference Values for Clinical Application. J Clin Med 2022; 11:jcm11102683. [PMID: 35628810 PMCID: PMC9145518 DOI: 10.3390/jcm11102683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
Unilateral lower limb amputations usually present with asymmetric interlimb gait patterns, in the long term leading to secondary physical conditions and carrying the risk of low physical activity and impairment of general health. To assess prosthetic fittings and rehabilitation measures, reference values for asymmetries as well as the most significant gait parameters are required. Kinetic gait data of 865 patients with unilateral lower limb amputations (hip and knee disarticulations, transfemoral, transtibial and foot amputations) and 216 able-bodied participants were quantitatively assessed by instrumented gait analyses. Characteristic spatiotemporal (stance time, walking speed, step length and width) and ground reaction force parameters (weight-acceptance and push-off peak) were contrasted to normal gait. All spatiotemporal and ground reaction force parameters differed significantly from normal gait with the largest differences in transfemoral amputations. These also differed between amputation levels and showed age-dependencies. The stance time and push-off peak difference were identified as the most discriminative parameters with the highest diagnostic specificity and sensitivity. The present results mark the first step to establishing universal reference values for gait parameters by means of which the quality and suitability of a prosthetic fitting and the rehabilitation progress can be assessed, and are generalizable for all adults with unilateral lower limb amputations in terms of level walking.
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Affiliation(s)
- Karin Schmid-Zalaudek
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria;
- Correspondence: (K.S.-Z.); (G.P.); Tel.: +43-316-385-73867 (K.S.-Z.); +43-5-9393-53201 (G.P.)
| | - Theresa Fischer
- Information and Communication Technology Division, Austrian Workers’ Compensation Board (AUVA), 1100 Vienna, Austria; (T.F.); (Z.S.)
| | - Zoltán Száva
- Information and Communication Technology Division, Austrian Workers’ Compensation Board (AUVA), 1100 Vienna, Austria; (T.F.); (Z.S.)
| | - Helmut Karl Lackner
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria;
| | - Ursula Kropiunig
- Rehabilitation Clinic Tobelbad, Austrian Workers’ Compensation Board (AUVA), 8144 Tobelbad, Austria;
| | - Christian Bittner
- Rehabilitation Center Häring, Austrian Workers’ Compensation Board (AUVA), 6323 Bad Häring, Austria;
| | - Karl Höcker
- Rehabilitation Center Weißer Hof, Austrian Workers’ Compensation Board (AUVA), 3400 Klosterneuburg, Austria; (K.H.); (G.W.)
| | - Günther Winkler
- Rehabilitation Center Weißer Hof, Austrian Workers’ Compensation Board (AUVA), 3400 Klosterneuburg, Austria; (K.H.); (G.W.)
| | - Gerfried Peternell
- Rehabilitation Clinic Tobelbad, Austrian Workers’ Compensation Board (AUVA), 8144 Tobelbad, Austria;
- Correspondence: (K.S.-Z.); (G.P.); Tel.: +43-316-385-73867 (K.S.-Z.); +43-5-9393-53201 (G.P.)
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12
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Kobayashi T, Koh MWP, Hu M, Murata H, Hisano G, Ichimura D, Hobara H. Effects of step frequency during running on the magnitude and symmetry of ground reaction forces in individuals with a transfemoral amputation. J Neuroeng Rehabil 2022; 19:33. [PMID: 35321725 PMCID: PMC8944140 DOI: 10.1186/s12984-022-01012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with unilateral transfemoral amputation are prone to developing health conditions such as knee osteoarthritis, caused by additional loading on the intact limb. Such individuals who can run again may be at higher risk due to higher ground reaction forces (GRFs) as well as asymmetric gait patterns. The two aims of this study were to investigate manipulating step frequency as a method to reduce GRFs and its effect on asymmetric gait patterns in individuals with unilateral transfemoral amputation while running. METHODS This is a cross-sectional study. Nine experienced track and field athletes with unilateral transfemoral amputation were recruited for this study. After calculation of each participant's preferred step frequency, each individual ran on an instrumented treadmill for 20 s at nine different metronome frequencies ranging from - 20% to + 20% of the preferred frequency in increments of 5% with the help of a metronome. From the data collected, spatiotemporal parameters, three components of peak GRFs, and the components of GRF impulses were computed. The asymmetry ratio of all parameters was also calculated. Statistical analyses of all data were conducted with appropriate tools based on normality analysis to investigate the main effects of step frequency. For parameters with significant main effects, linear regression analyses were further conducted for each limb. RESULTS Significant main effects of step frequency were found in multiple parameters (P < 0.01). Both peak GRF and GRF impulse parameters that demonstrated significant main effects tended towards decreasing magnitude with increasing step frequency. Peak vertical GRF in particular demonstrated the most symmetric values between the limbs from - 5% to 0% metronome frequency. All parameters that demonstrated significant effects in asymmetry ratio became more asymmetric with increasing step frequency. CONCLUSIONS For runners with a unilateral transfemoral amputation, increasing step frequency is a viable method to decrease the magnitude of GRFs. However, with the increase of step frequency, further asymmetry in gait is observed. The relationships between step frequency, GRFs, and the asymmetry ratio in gait may provide insight into the training of runners with unilateral transfemoral amputation for the prevention of injury.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mark W P Koh
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hiroto Murata
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.,Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.,Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan
| | - Hiroaki Hobara
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.
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13
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Symmetry Analysis of Amputee Gait Based on Body Center of Mass Trajectory and Discrete Fourier Transform. SENSORS 2020; 20:s20082392. [PMID: 32340117 PMCID: PMC7219319 DOI: 10.3390/s20082392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
The calculation of symmetry in amputee gait is a valuable tool to assess the functional aspects of lower limb prostheses and how it impacts the overall gait mechanics. This paper analyzes the vertical trajectory of the body center of mass (CoM) of a group formed by transfemoral amputees and non-amputees to quantitatively compare the symmetry level of this parameter for both cases. A decomposition of the vertical CoM into discrete Fourier series (DFS) components is performed for each subject’s CoM trajectory to identify the main components of each pattern. A DFS-based index is then calculated to quantify the CoM symmetry level. The obtained results show that the CoM displays different patterns along a gait cycle for each amputee, which differ from the sine-wave shape obtained in the non-amputee case. The CoM magnitude spectrum also reveals more coefficients for the amputee waveforms. The different CoM trajectories found in the studied subjects can be thought as the manifestation of developed compensatory mechanisms, which lead to gait asymmetries. The presence of odd components in the magnitude spectrum is related to the asymmetric behavior of the CoM trajectory, given the fact that this signal is an even function for a non-amputee gait. The DFS-based index reflects this fact due to the high value obtained for the non-amputee reference, in comparison to the low values for each amputee.
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14
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Petrini FM, Bumbasirevic M, Valle G, Ilic V, Mijović P, Čvančara P, Barberi F, Katic N, Bortolotti D, Andreu D, Lechler K, Lesic A, Mazic S, Mijović B, Guiraud D, Stieglitz T, Alexandersson A, Micera S, Raspopovic S. Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain. Nat Med 2019; 25:1356-1363. [PMID: 31501600 DOI: 10.1038/s41591-019-0567-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue1-4. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg5,6. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes7 in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.
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Affiliation(s)
- Francesco Maria Petrini
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.,SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Marko Bumbasirevic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giacomo Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Vladimir Ilic
- Faculty of Sport and Physical Education, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Paul Čvančara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Federica Barberi
- SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | | | | | - David Andreu
- Inria, University of Montpellier, Montpellier, France
| | | | - Aleksandar Lesic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Mazic
- Institute of Medical Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - David Guiraud
- Inria, University of Montpellier, Montpellier, France
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Cluster of Excellence BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland. .,SensArs Neuroprosthetics, Lausanne, Switzerland.
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15
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Zhang T, Bai X, Liu F, Fan Y. Effect of prosthetic alignment on gait and biomechanical loading in individuals with transfemoral amputation: A preliminary study. Gait Posture 2019; 71:219-226. [PMID: 31078826 DOI: 10.1016/j.gaitpost.2019.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inappropriate biomechanical loading usually leads to a high incidence of hip and knee osteoarthritis (OA) in individuals with lower-limb amputation, and prosthetic alignment may be an important influencing factor. The effect of alignment on the lower limb loading remains quantitatively unclear, and the relationship between malalignment and joint diseases is undefined. RESEARCH QUESTION How does alignment affect spatiotemporal gait parameters and ground reaction force (GRF) in individuals with transfemoral amputation? METHODS Gait tests of 10 individuals with transfemoral amputation were performed with recommended alignment and eight malalignments, including 10 mm socket translation (anterior, posterior, medial, and lateral) and 6° socket angular changes (flexion, extension, abduction, and adduction). Fifteen individuals without amputation were recruited as a control group. The differences in spatiotemporal and GRF parameters under different alignments were analyzed and compared with those of the control group. Statistical analyses were performed by one-way ANOVA, repeated measure multivariate ANOVA, and paired t tests. RESULTS The medial GRF peaks and impulse on both sides and load rate on the intact side are significantly higher than those of the control group (P < 0.0056). The propulsive and braking peaks, vertical impulse, and medial and vertical load rates of GRF on the intact side are higher than those on the residual side (P < 0.05). The alignment of socket adduction significantly increases medial GRF peak and impulse on both sides (P < 0.0056). SIGNIFICANCE Alignments exert remarkable and complicated effects on the biomechanical performance. The considerably higher GRF on the intact side of the individuals with transfemoral amputation may lead to internal stress changes of the intact joint, which may be an inducement for high incidence of joint diseases. Probably due to the increased lateral deviation of the center of gravity, the socket adduction alignment significantly increases medial GRF, which may lead to an increased risk of knee OA.
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Affiliation(s)
- Tengyu Zhang
- School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China; National Research Center for Rehabilitation Technical Aids, No.1, Ronghuazhonglu, BDA, Beijing, China; Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, No. 1, Ronghuazhonglu, BDA, Beijing, China
| | - Xuefei Bai
- National Research Center for Rehabilitation Technical Aids, No.1, Ronghuazhonglu, BDA, Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, No. 1, Ronghuazhonglu, BDA, Beijing, China
| | - Fei Liu
- National Research Center for Rehabilitation Technical Aids, No.1, Ronghuazhonglu, BDA, Beijing, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, haidian district, Beijing, China; National Research Center for Rehabilitation Technical Aids, No.1, Ronghuazhonglu, BDA, Beijing, China; Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, No. 1, Ronghuazhonglu, BDA, Beijing, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, No. 37, Xueyuan Road, haidian district, Beijing, China.
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16
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Crozara LF, Marques NR, LaRoche DP, Pereira AJ, Silva FCC, Flores RC, Payão SLM. Hip extension power and abduction power asymmetry as independent predictors of walking speed in individuals with unilateral lower-limb amputation. Gait Posture 2019; 70:383-388. [PMID: 30965183 DOI: 10.1016/j.gaitpost.2019.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/12/2019] [Accepted: 03/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Preferred walking speed (PWS) is an indicator of walking ability, prosthetic walking potential, and function following a lower-limb amputation (LLA). There is a link between lower-limb muscle performance and PWS in individuals with LLA. However, the ability of select hip muscle performance parameters to determine PWS in these individuals still needs to be thoroughly investigated. RESEARCH QUESTION Which hip muscle and joint torque parameters best determine PWS in persons with LLA? METHODS Seventeen patients with LLA (6 transfemoral, 4 knee disarticulation, and 7 transtibial; 16 men, 1 woman; mean age ± standard deviation, 56 ± 15yr) participated in this cross-sectional study. Maximal joint torque and power were evaluated unilaterally, for both amputated and intact limbs, in isometric and isokinetic conditions during hip flexion/extension (60°/s and 180°/s) and abduction/adduction (30°/s and 90°/s). PWS was measured at habitual walking speed over a 10-m distance. Pearson's correlation coefficient was used to verify the degree of association between each torque parameter and PWS and multiple regression analysis was performed to identify the best predictors of PWS. The level of significance was p < 0.05. RESULTS Correlations between hip muscle performance parameters and PWS were found in most cases (r = 0.51-0.82; p ≤ 0.036-0.0005). The multiple regression model revealed that the best independent predictors of PWS were hip extension power at 180°/s on the amputated side (r² = 0.672; p < 0.0005) and the asymmetry of hip abduction power at 30°/s (r² = -0.147; p < 0.008), accounting together for 82% of the variance in PWS. SIGNIFICANCE Lesser hip extension power on the amputated side and greater hip abduction power asymmetry between limbs are detrimental to PWS in persons with LLA. These muscle groups and performance parameters should be considered during gait rehabilitation to assist individuals with LLA in achieving functional waking speed.
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Affiliation(s)
- Luciano F Crozara
- Marília Medical School (FAMEMA), Monte-Carmelo-Av. 800, 17519030, Marília, São Paulo, Brazil.
| | - Nise R Marques
- Center of Health Sciences, University of the Sacred Heart (USC), Irmã-Arminda-Str. 10-50, 17011160, Bauru, São Paulo, Brazil.
| | - Dain P LaRoche
- Department of Kinesiology, University of New Hampshire (UNH), 124 Main Street, Durham, NH, 03824, USA.
| | - Alessandro J Pereira
- Lucy Montoro Rehabilitation Center, Nelson-Severino-Zambom-Av. 175, 17519110, Marília, São Paulo, Brazil.
| | - Francine C C Silva
- Lucy Montoro Rehabilitation Center, Nelson-Severino-Zambom-Av. 175, 17519110, Marília, São Paulo, Brazil.
| | - Roberta C Flores
- Lucy Montoro Rehabilitation Center, Nelson-Severino-Zambom-Av. 175, 17519110, Marília, São Paulo, Brazil.
| | - Spencer L M Payão
- Marília Medical School (FAMEMA), Monte-Carmelo-Av. 800, 17519030, Marília, São Paulo, Brazil.
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17
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Neamtu MC, Neamtu OM, Marin MI, Rusu L. Morphofunctional muscle changes influence on foot stability in multiple sclerosis during gait prediction: The rehabilitation potential. J Back Musculoskelet Rehabil 2018; 31:469-474. [PMID: 29171982 DOI: 10.3233/bmr-170925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiple sclerosis patients may suffer muscle changes that involve gait disorders of the kinetic and kinematic parameters also their gait may be clinically symmetrical or asymmetrical. OBJECTIVE The aim of this study is to analyze how the muscle change, could affect the biomechanical parameters of foot stability during the gait, by disturb the motor control. METHODS The study group consisted of 13 patients diagnosed with multiple sclerosis, presenting clinically detectable abnormal gait. The biomechanical evaluation included the foot axes and angles -external and internal rotation; the foot angle deviation from the gait direction; the subtalar angle. RESULTS The values of the foot angle were between -10.74∘ to 26.38∘ for the left foot and between -11.16∘ to 30.04∘ for the right foot. The foot axis angle is the axis of the foot in relation to the gait direction, and the subtalar angle is in relation to the vertical axis of the foot. The rotation of the right foot into pronation during the initial contact phase was followed by supination in the semi-support phase, to return to the neutral position during the propulsion phase, which meant being in free zone of minimal risk. CONCLUSIONS Biomechanical analysis of the foot angle and of subtalar angle in the patients with multiple sclerosis allows us to objectify the existence of a right-left asymmetry, the behavior ankle-foot during the gait. At the same time this evolution is closely correlated with the contact surface that tends to increase, which means involving the reflex mechanisms that place the foot in the zone of minimum risk and assure the stability of the body.
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Affiliation(s)
- Marius Cristian Neamtu
- Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Oana Maria Neamtu
- Department of Sports Medicine and Kinesiology, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Mihnea Ion Marin
- Department of Applied Mechanics, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ligia Rusu
- Department of Sports Medicine and Kinesiology, University of Craiova, Craiova, Romania.,Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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18
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Yang JR, Yang HS, Ahn DH, Ahn DY, Sim WS, Yang HE. Differences in Gait Patterns of Unilateral Transtibial Amputees With Two Types of Energy Storing Prosthetic Feet. Ann Rehabil Med 2018; 42:609-616. [PMID: 30180531 PMCID: PMC6129712 DOI: 10.5535/arm.2018.42.4.609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/18/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate if there is a difference in gait pattern when applying two different shapes of energy storing prosthetic feet for trainstibial amputation we conducted a comparative study. Energy storing prosthetic feet for transtibial amputation are increasing in use, but there are few studies that evaluate the effects of the shape of energy storing feet on gait patterns. METHODS Ten unilateral transtibial amputees were recruited. Two different shapes of dynamic response feet were applied to each subject either 1C30 Trias or 1C60 Triton. The main differences between the two are a split forefoot and the presence of a heel wedge. Spatiotemporal, kinematic, and kinetic data was obtained through gait analysis. Differences between intact and prosthetic side and differences between the two prosthetics were assessed. RESULTS On a side to side comparison, cadence asymmetry with 1C30 Trias was observed. Ankle plantarflexion at the end of stance and ankle supination at the onset of preswing was smaller with both prosthetic feet compared to the intact side. Other spatiotemporal, kinematic, and kinetic data showed no significant differences in a side to side comparison. In a comparison between the two prosthetics, stance and swing ratio and ankle dorsiflexion through mid-stance was closer to normal with 1C60 Triton than 1C30 Trias. Other spatiotemporal, kinematic, and kinetic data showed no statistically significant differences between prosthetics. CONCLUSION Both energy storing feet implants showed symmetric gait in unilateral transtibial amputees who are functionally independent in daily living. And 1C60 Triton showed closer to normal gait patterns than 1C30 Trias in our study.
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Affiliation(s)
- Ja Ryung Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Seung Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Da Hyun Ahn
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Young Ahn
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Woo Sob Sim
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Hea-Eun Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
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19
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Cutti AG, Verni G, Migliore GL, Amoresano A, Raggi M. Reference values for gait temporal and loading symmetry of lower-limb amputees can help in refocusing rehabilitation targets. J Neuroeng Rehabil 2018; 15:61. [PMID: 30255808 PMCID: PMC6157035 DOI: 10.1186/s12984-018-0403-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The literature suggests that optimal levels of gait symmetry might exist for lower-limb amputees. Not only these optimal values are unknown, but we also don’t know typical symmetry ratios or which measures of symmetry are essential. Focusing on the symmetries of stance, step, first peak and impulse of the ground reaction force, the aim of this work was to answer to three methodological and three clinical questions. The methodological questions wanted to establish a minimum set of symmetry indexes to study and if there are limitations in their calculations. The clinical questions wanted to establish if typical levels of temporal and loading symmetry exist, and change with the level of amputation and prosthetic components. Methods Sixty traumatic, K3-K4 amputees were involved in the study: 12 transfemoral mechanical knee users (TFM), 25 C-leg knee users (TFC), and 23 transtibial amputees (TT). Ninety-two percent used the Ossur Variflex foot. Ten healthy subjects were also included. Ground reaction force from both feet were collected with the Novel Pedar-X. Symmetry indexes were calculated and statistically compared with regression analyses and non-parametric analysis of variance among subjects. Results Stance symmetry can be reported instead of step, but it cannot substitute impulse and first peak symmetry. The first peak cannot always be detected on all amputees. Statistically significant differences exist for stance symmetry among all groups, for impulse symmetry between TFM and TFC/TT, for first peak symmetry between transfemoral amputees altogether and TT. Regarding impulse symmetry, 25% of TFC and 43% of TT had a higher impulse on the prosthetic side. Regarding first peak symmetry, 59% of TF and 30% of TT loaded more the prosthetic side. Conclusions Typical levels of symmetry for stance, impulse and first peak change with the level of amputation and componentry. Indications exist that C-leg and energy-storage-and-return feet can improve symmetry. Results are suggestive of two mechanisms related to sound side knee osteoarthritis: increased impulse for TF and increased first peak for TT. These results can be useful in clinics to set rehabilitation targets, understand the advancements of a patient during gait retraining, compare and chose components and possibly rehabilitation programs.
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Affiliation(s)
| | - Gennaro Verni
- INAIL Prosthetic Center, Via Rabuina 14, 40054, Vigorso di Budrio, BO, Italy
| | - Gian Luca Migliore
- INAIL Prosthetic Center, Via Rabuina 14, 40054, Vigorso di Budrio, BO, Italy
| | - Amedeo Amoresano
- INAIL Prosthetic Center, Via Rabuina 14, 40054, Vigorso di Budrio, BO, Italy
| | - Michele Raggi
- INAIL Prosthetic Center, Via Rabuina 14, 40054, Vigorso di Budrio, BO, Italy
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Relationship between Asymmetry of Gait and Muscle Torque in Patients after Unilateral Transfemoral Amputation. Appl Bionics Biomech 2018; 2018:5190816. [PMID: 29755583 PMCID: PMC5884243 DOI: 10.1155/2018/5190816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/10/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022] Open
Abstract
Many studies have shown that unilateral transfemoral amputation involves asymmetric gait. Transfemoral amputation leads to muscle atrophy in a tight stump resulting in asymmetry in muscle torque between the amputated and intact limb. This research is aimed at verifying if a relationship between torque values of hip joint flexors and extensors and gait asymmetry in patients with TFA exists. Fourteen adult subjects with unilateral TFA took part in the experiment. Gait symmetry was evaluated based on the ground reaction force (GRF). Measurements of muscle torque of hip flexors and extensors were taken with a Biodex System. All measurements were taken under isokinetic (60°/s and 120°/s) and isometric conditions. The symmetry index of vertical GRF components was from 7.5 to 11.5%, and anterio-posterior GRF from 6.2 to 9.3%. The symmetry index for muscle torque was from 24.3 to 44% for flexors, from 39 to 50.5% for extensors, and from 28.6 to 50% in the flexor/extensor ratio. Gait asymmetry correlated with muscle torque in hip joint extensors. Therapy which enhances muscle torque may be an effective form of patient therapy. The patient needs to undergo evaluation of their muscle strength and have the therapy programme adjusted to their level of muscle torque deficit.
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Creylman V, Knippels I, Janssen P, Biesbrouck E, Lechler K, Peeraer L. Assessment of transfemoral amputees using a passive microprocessor-controlled knee versus an active powered microprocessor-controlled knee for level walking. Biomed Eng Online 2016; 15:142. [PMID: 28105945 PMCID: PMC5249022 DOI: 10.1186/s12938-016-0287-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In transfemoral (TF) amputees, the forward propulsion of the prosthetic leg in swing has to be mainly carried out by hip muscles. With hip strength being the strongest predictor to ambulation ability, an active powered knee joint could have a positive influence, lowering hip loading and contributing to ambulation mobility. To assess this, gait of four TF amputees was measured for level walking, first while using a passive microprocessor-controlled prosthetic knee (P-MPK), subsequently while using an active powered microprocessor-controlled prosthetic knee (A-MPK). Furthermore, to assess long-term effects of the use of an A-MPK, a 4-weeks follow-up case study was performed. Methods The kinetics and kinematics of the gait of four TF amputees were assessed while walking with subsequently the P-MPK and the A-MPK. For one amputee, a follow-up study was performed: he used the A-MPK for 4 weeks, his gait was measured weekly. Results The range of motion of the knee was higher on both the prosthetic and the sound leg in the A-MPK compared to the P-MPK. Maximum hip torque (HT) during early stance increased for the prosthetic leg and decreased for the sound leg with the A-MPK compared to the P-MPK. During late stance, the maximum HT decreased for the prosthetic leg. The difference between prosthetic and sound leg for HT disappeared when using the A-MPK. Also, an increase in stance phase duration was observed. The follow-up study showed an increase in confidence with the A-MPK over time. Conclusions Results suggested that, partially due to an induced knee flexion during stance, HT can be diminished when walking with the A-MPK compared to the P-MPK. The single case follow-up study showed positive trends indicating that an adaptation time is beneficial for the A-MPK.
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Affiliation(s)
- Veerle Creylman
- Mobilab, Thomas More Kempen, Kleinhoefstraat 4, 2440, Geel, Belgium.
| | - Ingrid Knippels
- Mobilab, Thomas More Kempen, Kleinhoefstraat 4, 2440, Geel, Belgium
| | - Paul Janssen
- Mobilab, Thomas More Kempen, Kleinhoefstraat 4, 2440, Geel, Belgium
| | | | - Knut Lechler
- Ossur hf, R&D Medical Office, Grjothals 5-7, 110, Reykjavik, Iceland
| | - Louis Peeraer
- Mobilab, Thomas More Kempen, Kleinhoefstraat 4, 2440, Geel, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Louvain, Belgium
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Soares DP, de Castro MP, Mendes EA, Machado L. Principal component analysis in ground reaction forces and center of pressure gait waveforms of people with transfemoral amputation. Prosthet Orthot Int 2016; 40:729-738. [PMID: 26598512 DOI: 10.1177/0309364615612634] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The alterations in gait pattern of people with transfemoral amputation leave them more susceptible to musculoskeletal injury. Principal component analysis is a method that reduces the amount of gait data and allows analyzing the entire waveform. OBJECTIVES To use the principal component analysis to compare the ground reaction force and center of pressure displacement waveforms obtained during gait between able-bodied subjects and both limbs of individuals with transfemoral amputation. STUDY DESIGN This is a transversal study with a convenience sample. METHODS We used a force plate and pressure plate to record the anterior-posterior, medial-lateral and vertical ground reaction force, and anterior-posterior and medial-lateral center of pressure positions of 12 participants with transfemoral amputation and 20 able-bodied subjects during gait. The principal component analysis was performed to compare the gait waveforms between the participants with transfemoral amputation and the able-bodied individuals. RESULTS The principal component analysis model explained between 74% and 93% of the data variance. In all ground reaction force and center of pressure waveforms relevant portions were identified; and always at least one principal component presented scores statistically different (p < 0.05) between the groups of participants in these relevant portions. CONCLUSION Principal component analysis was able to discriminate many portions of the stance phase between both lower limbs of people with transfemoral amputation compared to the able-bodied participants. CLINICAL RELEVANCE Principal component analysis reduced the amount of data, allowed analyzing the whole waveform, and identified specific sub-phases of gait that were different between the groups. Therefore, this approach seems to be a powerful tool to be used in gait evaluation and following the rehabilitation status of people with transfemoral amputation.
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Affiliation(s)
- Denise Paschoal Soares
- Porto Biomechanics Laboratory and Faculty of Sport, University of Porto, Porto, Portugal
| | | | | | - Leandro Machado
- Porto Biomechanics Laboratory and Faculty of Sport, University of Porto, Porto, Portugal
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Turcato AM, Godi M, Giordano A, Schieppati M, Nardone A. The generation of centripetal force when walking in a circle: insight from the distribution of ground reaction forces recorded by plantar insoles. J Neuroeng Rehabil 2015; 12:4. [PMID: 25576354 PMCID: PMC4325939 DOI: 10.1186/1743-0003-12-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/22/2014] [Indexed: 11/27/2022] Open
Abstract
Background Turning involves complex reorientation of the body and is accompanied by asymmetric motion of the lower limbs. We investigated the distribution of the forces under the two feet, and its relation to the trajectory features and body medio-lateral displacement during curved walking. Methods Twenty-six healthy young participants walked under three different randomized conditions: in a straight line (LIN), in a circular clockwise path and in a circular counter-clockwise path. Both feet were instrumented with Pedar-X insoles. An accelerometer was fixed to the trunk to measure the medio-lateral inclination of the body. We analyzed walking speed, stance duration as a percent of gait cycle (%GC), the vertical component of the ground reaction force (vGRF) of both feet during the entire stance, and trunk inclination. Results Gait speed was faster during LIN than curved walking, but not affected by the direction of the curved trajectory. Trunk inclination was negligible during LIN, while the trunk was inclined toward the center of the path during curved trajectories. Stance duration of LIN foot and foot inside the curved trajectory (Foot-In) was longer than for foot outside the trajectory (Foot-Out). vGRF at heel strike was larger in LIN than in curved walking. At mid-stance, vGRF for both Foot-In and Foot-Out was higher than for LIN foot. At toe off, vGRF for both Foot-In and Foot-Out was lower than for LIN foot; in addition, Foot-In had lower vGRF than Foot-Out. During curved walking, a greater loading of the lateral heel occurred for Foot-Out than Foot-In and LIN foot. On the contrary, a smaller lateral loading of the heel was found for Foot-In than LIN foot. At the metatarsal heads, an opposite behaviour was seen, since lateral loading decreased for Foot-Out and increased for Foot-In. Conclusions The lower gait speed during curved walking is shaped by the control of trunk inclination and the production of asymmetric loading of heel and metatarsal heads, hence by the different contribution of the feet in producing the body inclination towards the centre of the trajectory.
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Affiliation(s)
- Anna Maria Turcato
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno, Fondazione Salvatore Maugeri (IRCCS), Veruno, NO, Italy.
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