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Rubin N, Hinson R, Saul K, Filer W, Hu X, Huang H(H. Modified motor unit properties in residual muscle following transtibial amputation. J Neural Eng 2024; 21:10.1088/1741-2552/ad1ac2. [PMID: 38176027 PMCID: PMC11214693 DOI: 10.1088/1741-2552/ad1ac2] [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: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 01/06/2024]
Abstract
Objective.Neural signals in residual muscles of amputated limbs are frequently decoded to control powered prostheses. Yet myoelectric controllers assume muscle activities of residual muscles are similar to that of intact muscles. This study sought to understand potential changes to motor unit (MU) properties after limb amputation.Approach.Six people with unilateral transtibial amputation were recruited. Surface electromyogram (EMG) of residual and intacttibialis anterior(TA) andgastrocnemius(GA) muscles were recorded while subjects traced profiles targeting up to 20% and 35% of maximum activation for each muscle (isometric for intact limbs). EMG was decomposed into groups of MU spike trains. MU recruitment thresholds, action potential amplitudes (MU size), and firing rates were correlated to model Henneman's size principle, the onion-skin phenomenon, and rate-size associations. Organization (correlation) and modulation (rates of change) of relations were compared between intact and residual muscles.Main results.The residual TA exhibited significantly lower correlation and flatter slopes in the size principle and onion-skin, and each outcome covaried between the MU relations. The residual GA was unaffected for most subjects. Subjects trained prior with myoelectric prostheses had minimally affected slopes in the TA. Rate-size association correlations were preserved, but both residual muscles exhibited flatter decay rates.Significance.We showed peripheral neuromuscular damage also leads to spinal-level functional reorganizations. Our findings suggest models of MU recruitment and discharge patterns for residual muscle EMG generation need reparameterization to account for disturbances observed. In the future, tracking MU pool adaptations may also provide a biomarker of neuromuscular control to aid training with myoelectric prostheses.
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Affiliation(s)
- Noah Rubin
- UNC/NC State Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Robert Hinson
- UNC/NC State Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
- UNC/NC State Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Katherine Saul
- Department of Mechanical & Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
| | - William Filer
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Xiaogang Hu
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802, United States of America
| | - He (Helen) Huang
- UNC/NC State Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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Major MJ, Stine RL. Sensorimotor function and standing balance in older adults with transtibial limb loss. Clin Biomech (Bristol, Avon) 2023; 109:106104. [PMID: 37757679 DOI: 10.1016/j.clinbiomech.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Limited research has focused on older prosthesis users despite the expected compounded effects of age and amputation on sensorimotor function, balance, and falls. This study compared sensorimotor factors and standing balance between older individuals with and without transtibial amputation, hypothesizing that prosthesis users would demonstrate worse sensorimotor function. Secondarily we assessed the relationship between standing balance and somatosensation in prosthesis users. METHODS Thirteen persons with unilateral transtibial amputation (71.7 years) and 10 able-bodied controls (71.7 years) participated in this cross-sectional observational study. Passive joint range-of-motion, muscle strength, proprioception (joint position sense), tactile sensitivity, and standing balance (center-of-pressure sway) were compared between groups. A multiple linear regression analysis assessed the relationship between proprioception and balance (without vision) in prosthesis users. FINDINGS Our hypotheses were generally not supported, with the only differences being reduced joint range-of-motion and strength in prosthesis users (with large effect sizes), but comparable sensation and balance. Notably, prosthesis users demonstrated better proprioception than controls as reflected through better joint position sense when the limb was non-weight bearing. Worse amputated limb proprioception was associated with better standing balance in prosthesis users. INTERPRETATION Older prosthesis users have impaired passive joint motion and muscle strength compared to controls that could challenge their ability to position and control the amputated limb to avoid falls during daily activities. However, their better amputated limb proprioception might help counteract those limitations by leveraging sensory feedback from the suspended limb. The relationship between amputated limb proprioception and standing balance suggests a nuanced relationship that warrants further study.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, USA.
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Burton H, Iliadis AD, Jones N, Saini A, Bystrzonowski N, Vris A, Pafitanis G. Osteocutaneous Turn-Up Fillet Flaps: A Spare-Parts Orthoplastic Surgery Option for a Functional Posttraumatic Below-Knee Amputation. Arch Plast Surg 2023; 50:501-506. [PMID: 37808330 PMCID: PMC10556299 DOI: 10.1055/a-2033-5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/12/2023] [Indexed: 02/13/2023] Open
Abstract
This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.
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Affiliation(s)
- Harry Burton
- London Reconstructive Microsurgery Unit, Emergency Care and Trauma Division, Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Alexios Dimitrios Iliadis
- Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Neil Jones
- Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Aaron Saini
- Trauma and Limb Reconstruction Unit, Department of Trauma and Orthopaedics, King's College Hospital Foundation Trust, London, United Kingdom
| | - Nicola Bystrzonowski
- Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Alexandros Vris
- Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Georgios Pafitanis
- London Reconstructive Microsurgery Unit, Emergency Care and Trauma Division, Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Department of Medical Sciences, Medical School, University of Cyprus, Nicosia, Cyprus
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Valette R, Gonzalez-Vargas J, Dosen S. The impact of walking on the perception of multichannel electrotactile stimulation in individuals with lower-limb amputation and able-bodied participants. J Neuroeng Rehabil 2023; 20:108. [PMID: 37592336 PMCID: PMC10436512 DOI: 10.1186/s12984-023-01234-4] [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: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND One of the drawbacks of lower-limb prostheses is that they do not provide explicit somatosensory feedback to their users. Electrotactile stimulation is an attractive technology to restore such feedback because it enables compact solutions with multiple stimulation points. This allows stimulating a larger skin area to provide more information concurrently and modulate parameters spatially as well as in amplitude. However, for effective use, electrotactile stimulation needs to be calibrated and it would be convenient to perform this procedure while the subject is seated. However, amplitude and spatial perception can be affected by motion and/or physical coupling between the residual limb and the socket. In the present study, we therefore evaluated and compared the psychometric properties of multichannel electrotactile stimulation applied to the thigh/residual limb during sitting versus walking. METHODS The comprehensive assessment included the measurement of the sensation and discomfort thresholds (ST & DT), just noticeable difference (JND), number of distinct intervals (NDI), two-point discrimination threshold (2PD), and spatial discrimination performance (SD). The experiment involved 11 able-bodied participants (4 females and 7 males; 29.2 ± 3.8 years), 3 participants with transtibial amputation, and 3 participants with transfemoral amputation. RESULTS In able-bodied participants, the results were consistent for all the measured parameters, and they indicated that both amplitude and spatial perception became worse during walking. More specifically, ST and DT increased significantly during walking vs. sitting (2.90 ± 0.82 mA vs. 2.00 ± 0.52 mA; p < 0.001 for ST and 7.74 ± 0.84 mA vs. 7.21 ± 1.30 mA; p < 0.05 for DT) and likewise for the JND (22.47 ± 12.21% vs. 11.82 ± 5.07%; p < 0.01), while the NDI became lower (6.46 ± 3.47 vs. 11.27 ± 5.18 intervals; p < 0.01). Regarding spatial perception, 2PD was higher during walking (69.78 ± 17.66 mm vs. 57.85 ± 14.87 mm; p < 0.001), while the performance of SD was significantly lower (56.70 ± 10.02% vs. 64.55 ± 9.44%; p < 0.01). For participants with lower-limb amputation, the ST, DT, and performance in the SD assessment followed the trends observed in the able-bodied population. The results for 2PD and JND were however different and subject-specific. CONCLUSION The conducted evaluation demonstrates that electrotactile feedback should be calibrated in the conditions in which it will be used (e.g., during walking). The calibration during sitting, while more convenient, might lead to an overly optimistic (or in some cases pessimistic) estimate of sensitivity. In addition, the results underline that calibration is particularly important in people affected by lower-limb loss to capture the substantial variability in the conditions of the residual limb and prosthesis setup. These insights are important for the implementation of artificial sensory feedback in lower-limb prosthetics applications.
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Affiliation(s)
- Romain Valette
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Petersen BA, Sparto PJ, Fisher LE. Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation. Gait Posture 2023; 99:104-110. [PMID: 36375214 PMCID: PMC9970031 DOI: 10.1016/j.gaitpost.2022.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/30/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND In addition to a range of functional impairments seen in individuals with a lower-limb amputation, this population is at a substantially elevated risk of falls. Studies postulate that the lack of sensory feedback from the prosthetic limb contributes heavily to these impairments, but the extent to which sensation affects functional measures remains unclear. RESEARCH QUESTION The purpose of this study is to determine how sensory impairments in the lower extremities relate to performance with common clinical functional measures of balance and gait in individuals with a lower-limb amputation. Here we evaluate the effects of somatosensory integrity to clinical and lab measures of static, reactive and dynamic balance, and gait stability. METHODS In 20 individuals with lower-limb amputation (AMP) and 20 age and gender-matched able-bodied controls (CON), we evaluated the effects of sensory integrity (pressure, proprioception, and vibration) on measures of balance and gait. Static, reactive, and dynamic balance were assessed using the Sensory Organization Test (SOT), Motor Control Test (MCT), and Functional Gait Assessment (FGA), respectively. Gait stability was assessed through measures of step length asymmetry and step width variability. Sensation was categorized into intact or impaired sensation by pressure thresholds and differences across groups were analyzed. RESULTS There were significant differences between AMP and CON groups for reliance on vision for static balance in the SOT, MCT, and FGA (p < 0.01). Despite differences across groups, there were no significant differences within the AMP group based on intact or impaired sensation across all functional measures. SIGNIFICANCE Despite being able to detect differences between able-bodied individuals and individuals with an amputation, these functional measures cannot distinguish between levels of impairment within participants with an amputation. These findings suggest that more challenging and robust metrics are needed to evaluate the effects of sensation and function in individuals with an amputation.
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Affiliation(s)
- B A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - P J Sparto
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - L E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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Han Y, Lu Y, Zuo Y, Song H, Chou CH, Wang X, Li X, Li L, Niu CM, Hou W. Substitutive proprioception feedback of a prosthetic wrist by electrotactile stimulation. Front Neurosci 2023; 17:1135687. [PMID: 36895418 PMCID: PMC9989268 DOI: 10.3389/fnins.2023.1135687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Sensory feedback of upper-limb prostheses is widely desired and studied. As important components of proprioception, position, and movement feedback help users to control prostheses better. Among various feedback methods, electrotactile stimulation is a potential method for coding proprioceptive information of a prosthesis. This study was motivated by the need for proprioception information for a prosthetic wrist. The flexion-extension (FE) position and movement information of the prosthetic wrist are transmitted back to the human body through multichannel electrotactile stimulation. Approach We developed an electrotactile scheme to encode the FE position and movement of the prosthetic wrist and designed an integrated experimental platform. A preliminary experiment on the sensory threshold and discomfort threshold was performed. Then, two proprioceptive feedback experiments were performed: a position sense experiment (Exp 1) and a movement sense experiment (Exp 2). Each experiment included a learning session and a test session. The success rate (SR) and discrimination reaction time (DRT) were analyzed to evaluate the recognition effect. The acceptance of the electrotactile scheme was evaluated by a questionnaire. Main results Our results showed that the average position SRs of five able-bodied subjects, amputee 1, and amputee 2 were 83.78, 97.78, and 84.44%, respectively. The average movement SR, and the direction and range SR of wrist movement in five able-bodied subjects were 76.25, 96.67%, respectively. Amputee 1 and amputee 2 had movement SRs of 87.78 and 90.00% and direction and range SRs of 64.58 and 77.08%, respectively. The average DRT of five able-bodied subjects was less than 1.5 s and that of amputees was less than 3.5 s. Conclusion The results indicate that after a short period of learning, the subjects can sense the position and movement of wrist FE. The proposed substitutive scheme has the potential for amputees to sense a prosthetic wrist, thus enhancing the human-machine interaction.
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Affiliation(s)
- Yichen Han
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
| | - Yinping Lu
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
| | - Yufeng Zuo
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
| | - Hongliang Song
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
| | - Chih-Hong Chou
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xing Wang
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
| | - Xiangxin Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, Guangdong, China
| | - Lei Li
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Chuanxin M Niu
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wensheng Hou
- Biomedical Engineering Department, Bioengineering College, Chongqing University, Chongqing, China
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Seth M, Beisheim-Ryan EH, Pohlig RT, Horne JR, Hicks GE, Sions JM. Vibration Sensitivity Is Associated With Functional Balance After Unilateral Transtibial Amputation. Arch Rehabil Res Clin Transl 2022; 3:100161. [PMID: 34977543 PMCID: PMC8683871 DOI: 10.1016/j.arrct.2021.100161] [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] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate differences in vibration perception thresholds between adults with transtibial amputation and age-matched adults without amputation and to examine associations between vibration perception thresholds and balance performance. We hypothesized that adults with transtibial amputation would demonstrate lower thresholds compared with adults without amputation and that lower thresholds would be associated with better functional balance. Design Prospective cross-sectional study. Setting National conference, clinical practice, and university laboratory. Participants Adults (N=34) with a nondysvascular, unilateral, transtibial amputation and 43 age-matched controls without amputation. Interventions Participants' vibration perception thresholds were evaluated bilaterally by applying a vibration stimulus to the midpatella and recording their verbal response to conscious perception of stimulus. Functional balance was assessed with the Berg Balance Scale and the Four Square Step Test. Main Outcome Measures Residual and sound limb (right and left for controls) vibration perception thresholds, Berg Balance Scale, and Four Square Step Test. Results For participants with transtibial amputation and controls, there were no significant between-group (P=.921) or interlimb (P=.540) differences in vibration perception thresholds. Overall, robust regression models explained 35.1% and 19.3% variance in Berg Balance Scale scores and Four Square Step Test times, respectively. Among adults with transtibial amputation, vibration perception thresholds were negatively associated with Berg Balance Scale scores (P=.009) and positively associated with Four Square Step Test times (P=.048). Among controls, average vibration perception thresholds were not significantly associated with functional balance (P>.050). Conclusions Adults with nondysvascular, transtibial-level amputation demonstrated similar vibration detection compared with adults with intact limbs, indicating that vibration detection is preserved in the amputated region postamputation. These findings suggest a unique relationship between vibration perception and functional balance post-transtibial amputation.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Emma H Beisheim-Ryan
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Ryan T Pohlig
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Gregory E Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Jaclyn M Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
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Bradley SS, Howe E, Bailey CDC, Vickaryous MK. The dendrite arbor of Purkinje cells is altered following to tail regeneration in the leopard gecko. Integr Comp Biol 2021; 61:370-384. [PMID: 34038505 DOI: 10.1093/icb/icab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purkinje cells of the cerebellum have a complex arborized arrangement of dendrites and are amongst the most distinctive cell types of the nervous system. Although the neuromorphology of Purkinje cells has been well described for some mammals and teleost fish, for most vertebrates less is known. Here we used a modified Golgi-Cox method to investigate the neuromorphology of Purkinje cells from the lizard Eublepharis macularius, the leopard gecko. Using Sholl and Branch Structure Analyses, we sought to investigate whether the neuromorphology of gecko Purkinje cells was altered is response to tail loss and regeneration. Tail loss is an evolved mechanism commonly used by geckos to escape predation. Loss of the tail represents a significant and sudden change in body length and mass, which is only partially recovered as the tail is regenerated. We predicted that tail loss and regeneration would induce a quantifiable change in Purkinje cell dendrite arborization. Post hoc comparisons of Sholl analyses data showed that geckos with regenerated tails have significant changes in dendrite diameter and the number of dendrite intersections in regions corresponding to the position of parallel fiber synapses. We propose that the neuromorphological alterations observed in gecko Purkinje cells represent a compensatory response to tail regrowth, and perhaps a role in motor learning.
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Affiliation(s)
| | - Erika Howe
- Department of Human Health and Nutritional Sciences, University of Guelph, Canada
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Houdijk H, Blokland IJ, Nazier SA, Castenmiller SV, van den Heuvel I, IJmker T. Effects of Handrail and Cane Support on Energy Cost of Walking in People With Different Levels and Causes of Lower Limb Amputation. Arch Phys Med Rehabil 2021; 102:1340-1346.e3. [PMID: 33684364 DOI: 10.1016/j.apmr.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The energy cost of walking with a lower limb prosthesis is higher than able-bodied walking and depends on both cause and level of amputation. This increase might partly be related to problems with balance control. In this study we investigated to what extent energy cost can be reduced by providing support through a handrail or cane and how this depends on level and cause of amputation. DESIGN Quasi-experimental study. SETTING Rehabilitation gait laboratory. PARTICIPANTS Twenty-six people with a lower limb amputation were included: 9 with vascular and 17 with nonvascular causes, 16 at transtibial, and 10 at transfemoral or knee disarticulation level (N=26). INTERVENTIONS Participants walked on a treadmill with and without handrail support and overground with and without a cane. MAIN OUTCOME MEASURES Energy cost was assessed using respirometry. RESULTS On the treadmill, handrail support resulted in a 6% reduction in energy cost on average. This effect was attributed to an 11% reduction in those with an amputation attributable to vascular causes, whereas the nonvascular group did not show a significant difference. No interaction with level of amputation was found. Overground, no main effect of cane support was found, although an interaction effect with cause of amputation demonstrated a small nonsignificant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the nonvascular group when walking with a cane. The effect of support was positively correlated with self-selected walking speed. CONCLUSIONS This study demonstrates that providing external support can contribute to a reduction in energy cost in people with an amputation due to vascular causes with reduced walking ability while walking in the more challenging condition of the treadmill. Although it is speculated that this effect might be related to problems with balance control, this will need further investigation.
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Affiliation(s)
- Han Houdijk
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
| | - Ilse J Blokland
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Suci A Nazier
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Poltekkes Kemenkes Jakarta 1, Jakarta School Prosthetics and Orthotics (JSPO), Jakarta, Indonesia
| | - Saskia V Castenmiller
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Iris van den Heuvel
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Trienke IJmker
- Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bradley SS, Howe E, Bent LR, Vickaryous MK. Cutaneous tactile sensitivity before and after tail loss and regeneration in the leopard gecko (Eublepharis macularius). J Exp Biol 2021; 224:jeb.234054. [DOI: 10.1242/jeb.234054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022]
Abstract
ABSTRACT
Amongst tetrapods, mechanoreceptors on the feet establish a sense of body placement and help to facilitate posture and biomechanics. Mechanoreceptors are necessary for stabilizing the body while navigating through changing terrains or responding to a sudden change in body mass and orientation. Lizards such as the leopard gecko (Eublepharis macularius) employ autotomy – a voluntary detachment of a portion of the tail – to escape predation. Tail autotomy represents a natural form of significant (and localized) mass loss. Semmes–Weinstein monofilaments were used to investigate the effect of tail autotomy (and subsequent tail regeneration) on tactile sensitivity of each appendage of the leopard gecko. Prior to autotomy, we identified site-specific differences in tactile sensitivity across the ventral surfaces of the hindlimbs, forelimbs and tail. Repeated monofilament testing of both control (tail-intact) and tail-loss geckos had a significant sensitization effect (i.e. decrease in tactile threshold, maintained over time) in all regions of interest except the palmar surfaces of the forelimbs in post-autotomy geckos, compared with baseline testing. Although the regenerated tail is not an exact replica of the original, tactile sensitivity is shown to be effectively restored at this site. Re-establishment of tactile sensitivity on the ventral surface of the regenerate tail points towards a (continued) role in predator detection.
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Affiliation(s)
- Stefanie S. Bradley
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, N1G2W1, Canada
| | - Erika Howe
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, N1G2W1, Canada
| | - Leah R. Bent
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, N1G2W1, Canada
| | - Matthew K. Vickaryous
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, N1G2W1, Canada
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Miyata Y, Sasaki K, Guerra G, Rattanakoch J. Sustainable, affordable and functional: reimagining prosthetic liners in resource limited environments. Disabil Rehabil 2020; 44:2941-2947. [PMID: 33167733 DOI: 10.1080/09638288.2020.1844316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate function and performance of unilateral trans-tibial prosthesis users wearing an affordable liner in three types of socket designs. METHODS Five unilateral trans-tibial amputees participated, were provided an Affordable Ethyl-Vinyl-Acetate Roll-On liner (AERO) roll-on liner with patella tendon bearing (PTB) prosthesis, PE-Lite liner with PTB prosthesis, and an (AERO) liner with total-surface bearing (TSB) prosthesis. A battery of outcome measures; step-counts, socket comfort score (SCS), orthotics prosthetics user survey (OPUS) and socket pressure measurement during walking were administered. RESULTS Comparisons of step-counts indicated that PTB-AERO (3604 ± 815) was not significantly different than PTB-PE-Lite (3386 ± 942). Mean SCS was 9.2 ± .83 and 7.2 ± 2.1 for PTB-AERO and PTB-PE-Lite. A 6.6% decrease in mean peak pressure was observed between PTB-PE-Lite and TSB-AERO, and 3.2% difference between PTB-PE-Lite and PTB-AERO. CONCLUSION An affordable ($20 USD) and sustainably fabricated prosthesis liner was created and evaluated in trans-tibial prosthesis users. These initial results garner preliminary support for use of the AERO prosthetic liner and continued research.Implications for rehabilitationLower limb prosthetics in less-resourced settings can leverage locally sourced and affordable materials to fabricate roll-on liners for use in modern prosthetic sockets.The cost of the AERO liner is markedly lower than current standard of care gel liners, yet still facilitates use of current prosthetic sockets.
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Affiliation(s)
- Yusuke Miyata
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kazuhiko Sasaki
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gary Guerra
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jutima Rattanakoch
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Petrus E, Dembling S, Usdin T, Isaac JTR, Koretsky AP. Circuit-Specific Plasticity of Callosal Inputs Underlies Cortical Takeover. J Neurosci 2020; 40:7714-7723. [PMID: 32913109 PMCID: PMC7531555 DOI: 10.1523/jneurosci.1056-20.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/13/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
Injury induces synaptic, circuit, and systems reorganization. After unilateral amputation or stroke, this functional loss disrupts the interhemispheric interaction between intact and deprived somatomotor cortices to recruit deprived cortex in response to intact limb stimulation. This recruitment has been implicated in enhanced intact sensory function. In other patients, maladaptive consequences such as phantom limb pain can occur. We used unilateral whisker denervation in male and female mice to detect circuitry alterations underlying interhemispheric cortical reorganization. Enhanced synaptic strength from the intact cortex via the corpus callosum (CC) onto deep neurons in deprived primary somatosensory barrel cortex (S1BC) has previously been detected. It was hypothesized that specificity in this plasticity may depend on to which area these neurons projected. Increased connectivity to somatomotor areas such as contralateral S1BC, primary motor cortex (M1) and secondary somatosensory cortex (S2) may underlie beneficial adaptations, while increased connectivity to pain areas like anterior cingulate cortex (ACC) might underlie maladaptive pain phenotypes. Neurons from the deprived S1BC that project to intact S1BC were hyperexcitable, had stronger responses and reduced inhibitory input to CC stimulation. M1-projecting neurons also showed increases in excitability and CC input strength that was offset with enhanced inhibition. S2 and ACC-projecting neurons showed no changes in excitability or CC input. These results demonstrate that subgroups of output neurons undergo dramatic and specific plasticity after peripheral injury. The changes in S1BC-projecting neurons likely underlie enhanced reciprocal connectivity of S1BC after unilateral deprivation consistent with the model that interhemispheric takeover supports intact whisker processing.SIGNIFICANCE STATEMENT Amputation, peripheral injury, and stroke patients experience widespread alterations in neural activity after sensory loss. A hallmark of this reorganization is the recruitment of deprived cortical space which likely aids processing and thus enhances performance on intact sensory systems. Conversely, this recruitment of deprived cortical space has been hypothesized to underlie phenotypes like phantom limb pain and hinder recovery. A mouse model of unilateral denervation detected remarkable specificity in alterations in the somatomotor circuit. These changes underlie increased reciprocal connectivity between intact and deprived cortical hemispheres. This increased connectivity may help explain the enhanced intact sensory processing detected in humans.
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Affiliation(s)
- Emily Petrus
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892
| | - Sarah Dembling
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892
| | - Ted Usdin
- Systems Neuroscience Imaging Resource, National Institute of Mental Health, Bethesda, Maryland 20892
| | - John T R Isaac
- Janssen Neuroscience, J&J Innovations, London W1G 0BG, United Kingdom
| | - Alan P Koretsky
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892
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