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Tracy JB, Gaffney BMM, Thomsen PB, Awad ME, Melton DH, Christiansen CL, Stoneback JW. Dynamic gait stability and stability symmetry for people with transfemoral amputation: A case-series of 19 individuals with bone-anchored limbs. J Biomech 2024; 171:112208. [PMID: 38941842 DOI: 10.1016/j.jbiomech.2024.112208] [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: 01/10/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
For some individuals with severe socket-related problems, prosthesis osseointegration directly connects a prosthesis to the residual limb creating a bone-anchored limb (BAL). We compared dynamic gait stability and between-limb stability symmetry, as measured by the Margin of Stability (MoS) and the Normalized Symmetry Index (NSI), for people with unilateral transfemoral amputation before and one-year after BAL implantation. The MoS provides a mechanical construct to assess dynamic gait stability and infer center of mass and limb control by relating the center of mass and velocity to the base of support. Before and one-year after BAL implantation, 19 participants walked overground at self-selected speeds. We quantified dynamic gait stability anteriorly and laterally at foot strike and at the minimum lateral MoS value. After implantation, we observed decreased lateral MoS at foot strike for the amputated (MoS mean(SD) %height; pre: 6.6(2.3), post: 5.9(1.3), d = 0.45) and intact limb (pre: 6.2(1.2), post: 5.8(1.0), d = 0.38) and increased between-limb MoS symmetry at foot strike (NSI mean(SD) %; anterior-pre: 10.3(7.3), post: 8.4(3.6), d = 0.23; lateral-pre: 18.8(12.4), post: 12.4(4.9), d = 0.47) and at minimum lateral stability (pre: 28.1(18.1), post: 19.2(6.8), d = 0.50). Center of mass control using a BAL resulted in dynamic gait stability more similar between limbs and may have reduced the adoption of functional asymmetries. We suggest that improved between-limb MoS symmetry after BAL implantation is likely due to subtle changes in individual limb MoS values at self-selected walking speeds resulting in an overall positive impact on fall risk through improved center of mass and prosthetic limb control.
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Affiliation(s)
- James B Tracy
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veteran's Affairs Eastern Colorado Healthcare System, Aurora, CO, USA.
| | - Brecca M M Gaffney
- Veteran's Affairs Eastern Colorado Healthcare System, Aurora, CO, USA; Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter B Thomsen
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veteran's Affairs Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Mohamed E Awad
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Danielle H Melton
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veteran's Affairs Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Bisele M, Bencsik M, Lewis MGC, Barnett CT. Attempted symmetry affects dynamic gait stability in individuals with lower-limb amputation. Gait Posture 2024; 107:182-188. [PMID: 37949725 DOI: 10.1016/j.gaitpost.2023.09.015] [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: 10/18/2022] [Revised: 08/16/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Gait in people with lower limb amputation (LLA) is typically asymmetrical. Reducing this asymmetry is often attempted to minimise the impact of secondary health issues. However, temporal-spatial asymmetry in gait of people with LLA has also been shown to underpin dynamic stability. RESEARCH QUESTION The current study aimed to identify the effects of acute attempts to achieve temporal-spatial symmetry on the dynamic stability of people with unilateral transtibial amputation (UTA). The secondary aim of this study was to identify the corresponding biomechanical adaptations during attempted symmetrical gait. METHODS Eleven people with UTA walked along a 15 m walkway in four different conditions: normal (NORM), attempted symmetrical step length and step frequency (SYMSL+SF) attempted symmetrical step length (SYMSL) and attempted symmetrical step frequency (SYMSF). Dynamic stability was measured using the backward (BW) and medio-lateral (ML) margins of stability (MoS). RESULTS Results indicate that attempting SYMSF had a positive effect on gait stability in BW and ML directions, while attempting SYMSL had a potentially negative effect, although these results did not appear to be significant. The absence of clustering in principal component analysis, supported the lack of significant results, indicating no features differentiating between conditions of attempted symmetry. Conversely, there was clustering by limbs which were associated with differences in knee and ankle joint angles between the prosthetic and non-prosthetic limbs, and clustering by individuals highlighting the importance of patient-specific analysis. CONCLUSION The data suggests that attempted symmetrical gait reduces asymmetry but also affects dynamic stability.
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Affiliation(s)
- Maria Bisele
- BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany.
| | - Martin Bencsik
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Persine S, Simoneau-Buessinger E, Charlaté F, Bassement J, Gillet C, Découfour N, Leteneur S. Transfemoral amputees adapt their gait during cross-slope walking with specific upper-lower limb coordination. Gait Posture 2023; 105:171-176. [PMID: 37579592 DOI: 10.1016/j.gaitpost.2023.08.001] [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: 05/06/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Unilateral lower limb amputees have asymmetrical gaits, particularly on irregular surfaces and slopes. It is unclear how coordination between arms and legs can adapt during cross-slope walking. RESEARCH QUESTION How do transfemoral amputees (TFAs) adapt their upper-lower limb coordination on cross-slope surfaces? METHODS Twenty TFA and 20 healthy adults (Ctrl) performed a three-dimensional gait analysis in 2 walking conditions: level ground and cross-slope with prosthesis uphill. Sagittal joint angles and velocities of hips and shoulders were calculated. Continuous relative phases (CRP) were computed between the shoulder and the hip of the opposite side. The closer to 0 the CRP is, the more coordinated the joints are. Curve analysis were conducted using SPM. RESULTS The mean CRP between the downhill shoulder and the uphill hip was higher in TFA compared to Ctrl (p = 0.02), with a walking conditions effect (p = 0.005). TFA showed significant differences about the end of the stance phase (p = 0.01) between level ground and cross-slope, while Ctrl showed a significant difference (p = 0.008) between these walking conditions at the end of the swing phase. In CRP between the uphill shoulder and the downhill hip, SnPM analysis showed intergroup differences during the stance phase (p < 0.05), but not in the comparison between walking conditions in TFA and Ctrl groups. SIGNIFICANCE TFA showed an asymmetrical coordination in level ground walking compared to Ctrl. Walking on cross-slope led to upper-lower limb coordination adaptations: this condition impacted the CRP between downhill shoulder and uphill hip in both groups. The management of the prosthetic limb, positioned uphill, induced a reorganization of the coordination with the upper limb of the amputated side. Identifying upper-lower limb coordination adaptations on cross-slope surfaces will help to achieve rehabilitation goals for effective walking in urban environments.
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Affiliation(s)
- S Persine
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | - E Simoneau-Buessinger
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - F Charlaté
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France
| | - J Bassement
- Institut Stablinski, Centre Hospitalier de Valenciennes, France
| | - C Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - N Découfour
- Faculté de Médecine et de Maïeutique, Institut Catholique de Lille, France
| | - S Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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Wong CK, Vandervort EE, Moran KM, Adler CM, Chihuri ST, Youdan GA. Walking asymmetry and its relation to patient-reported and performance-based outcome measures in individuals with unilateral lower limb loss. Int Biomech 2022; 9:33-41. [PMID: 36414237 PMCID: PMC9704090 DOI: 10.1080/23335432.2022.2142160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gait asymmetry persists for most people after lower limb amputation and is associated with slower walking speeds. However, the relationship between gait asymmetry and patient-reported function remains unclear because they are not commonly assessed together. The purpose of this study was to determine relationships between gait asymmetries in people with lower limb loss and (1) patient-reported outcomes and (2) performance-based prosthetic functional measures. This cross-sectional analysis included nine people with unilateral limb loss aged 48.2 ± 13.1 years of mixed amputation etiology. Patient-reported outcomes included the Prosthetic Evaluation Questionnaire mobility subscale and Activities-specific Balance Confidence scale. Performance outcomes included the Berg Balance Scale and the 30-second sit-to-stand test. Walking performance measures included the 2-Minute Walk Test, during which APDM Opal sensors recorded spatiotemporal gait parameters, and daily step-counts from StepWatch4 activity monitors. The study found that the most asymmetric gait symmetry ratios (prosthetic-limb divided by intact-limb) could be attributed to prosthetic foot dorsiflexion-plantarflexion and rotation motion limitations: prosthetic-limb trailing double support (0.789 ± 0.052), toe-off (0.760 ± 0.068) and toe-out angle (0.653 ± 0.256). Single limb stance, and stance and swing phase durations were most strongly associated with balance and walking performance measures. Notably, no symmetry ratio was significantly associated with patient-reported prosthetic function (unadjusted Pearson correlation coefficients r < 0.50, P > 0.05). More gait symmetry was associated with better balance and walking performance but had no significant relationship with patient-reported function. Although achieving gait symmetry after lower limb loss is a common walking goal, symmetry was unrelated to the perception of functional mobility for people with lower limb loss.
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Affiliation(s)
- Christopher K. Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA,CONTACT Christopher K. Wong Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th St, Georgian-311, New York, NY10032, USA
| | | | - Kayla M. Moran
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Carly M. Adler
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Stanford T. Chihuri
- School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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Seth M, Coyle PC, Pohlig RT, Beisheim EH, Horne JR, Hicks GE, Sions JM. Gait asymmetry is associated with performance-based physical function among adults with lower-limb amputation. Physiother Theory Pract 2022; 38:3108-3118. [PMID: 34657569 PMCID: PMC9013390 DOI: 10.1080/09593985.2021.1990449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/10/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adults with lower-limb amputation walk with an asymmetrical gait and exhibit poor functional outcomes, which may negatively impact quality-of-life. OBJECTIVE To evaluate associations between gait asymmetry and performance-based physical function among adults with lower-limb amputation. METHODS A cross-sectional study involving 38 adults with a unilateral transtibial (N = 24; 62.5 ± 10.5 years) or transfemoral amputation (N = 14; 59.9 ± 9.5 years) was conducted. Following gait analysis (capturing step length and stance time asymmetry at self-selected (SSWS) and fast walking speeds (FWS)), participants completed performance-based measures (i.e. Timed Up and Go (TUG), the 10-Meter Walk Test (10mwt), and the 6-Minute Walk Test (6MWT)). RESULTS Step length and stance time asymmetry (at SSWS and FWS) were significantly correlated with each performance-based measure (p < .001 to p = .035). Overall, models with gait measures obtained at SSWS explained 40.1%, 46.8% and 40.1% of the variance in TUG-time (p = .022), 10mwt-speed (p = .003) and 6MWT-distance (p = .010), respectively. Models with gait measures obtained at FWS explained 70.0%, 59.8% and 51.8% of the variance in TUG-time (p < .001), 10mwt-speed (p < .001), and 6MWT-distance (p < .001), respectively. CONCLUSIONS Increases in step length or stance time asymmetry are associated with increased TUG-time, slower 10mwt-speed, and reduced 6MWT-distance. Findings suggest gait asymmetry may be a factor in poor functional outcomes following lower-limb amputation.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Peter C Coyle
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE
| | - Emma H Beisheim
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - John R Horne
- Independence Prosthetics-Orthotics, Inc., Newark, DE
| | - Gregory E Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
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7
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Park S, Finley JM. Manual stabilization reveals a transient role for balance control during locomotor adaptation. J Neurophysiol 2022; 128:808-818. [PMID: 35946807 PMCID: PMC9550585 DOI: 10.1152/jn.00377.2021] [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: 08/27/2021] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 01/26/2023] Open
Abstract
A fundamental feature of human locomotor control is the need to adapt walking patterns in response to changes in the environment. For example, when people walk on a split-belt treadmill, which has belts that move at different speeds, they adapt to the asymmetric speed constraints by reducing spatiotemporal asymmetry. Here, we aim to understand the role of balance control as a potential factor driving this adaptation process. We recruited 24 healthy, young adults to adapt to walking on a split-belt treadmill while either holding on to a handrail or walking with free arm swing. We measured whole body angular momentum and step length asymmetry as measures of dynamic balance and spatiotemporal asymmetry, respectively. To understand how changes in intersegmental coordination influenced whole body angular momentum, we also measured segmental angular momenta and the coefficient of cancellation. When participants were initially exposed to the asymmetry in belt speeds, we observed an increase in whole body angular momentum that was due to both an increase in the momentum of individual segments and a reduction in the coefficient of cancellation. Holding on to a handrail reduced the perturbation to asymmetry during the early phase of adaptation and resulted in a smaller aftereffect during early postadaptation. In addition, the stabilization provided by holding on to a handrail led to reductions in the coupling between angular momentum and asymmetry. These results suggest that regulation of dynamic balance is most important during the initial, transient phase of adaptation to walking on a split-belt treadmill.NEW & NOTEWORTHY We investigated the role of dynamic balance during adaptation to a split-belt treadmill by measuring whole body angular momentum with or without holding on to a handrail. The initial step length asymmetry and associations between balance and asymmetry reduced when holding on to a handrail during early adaptation. These findings indicate that dynamic balance mostly contributes to the initial phase of adaptation when people are exposed to an asymmetric walking constraint.
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Affiliation(s)
- Sungwoo Park
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
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van Oorschot W, Hofstad CJ, Slagman D, Van Ee RF, Keijsers NLW. The effects of small variations in shoe heel height on gait in people with a transtibial amputation. Prosthet Orthot Int 2022; 46:252-257. [PMID: 35316261 DOI: 10.1097/pxr.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Shoe heel height is considered to influence prosthetic alignment, walking comfort, and gait symmetry in people with a transtibial amputation (TTA). However, research on the effect of heel height is scarce, and no evidence is available on the effects of variations smaller than 20 mm. These small heel height variations between store-bought shoes are often overlooked by people with an amputation and may cause secondary musculoskeletal problems in the long term. OBJECTIVE To examine the effects of small increases in heel height on gait symmetry in people with a TTA and healthy individuals. STUDY DESIGN Experimental repeated measures study. METHODS Fourteen participants with a TTA and 15 healthy controls were included. Pressure data, spatiotemporal data, and experienced walking comfort were measured during walking with four heel height conditions: original height and increased heights of 3, 5, and 8 mm. Symmetry in center of pressure velocity (VCOP), gait parameters, and experienced walking comfort were compared between the heel heights and between healthy controls and prosthetic walkers. RESULTS Increased heel height resulted in a significant decrease in VCOP symmetry (P = 0.001) and experienced walking comfort (P < 0.001). The VCOP trajectory of the prosthetic leg mainly differed within the first 14.5% of the stance phase. Healthy individuals showed better VCOP symmetry in all conditions (P < 0.001). CONCLUSIONS Healthcare professionals should advice their clients to be alert of small heel height differences between store-bought shoes, especially those larger than 5 mm. A prosthetic alignment adjustment should be considered when purchasing new shoes.
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Affiliation(s)
- Wieneke van Oorschot
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Daan Slagman
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Noël Leonardus Wilhelmus Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
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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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10
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Banks JJ, Wedge RD, Caldwell GE, Umberger BR. Are lower back demands reduced by improving gait symmetry in unilateral transtibial amputees? Clin Biomech (Bristol, Avon) 2022; 95:105657. [PMID: 35500413 DOI: 10.1016/j.clinbiomech.2022.105657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait asymmetry and a high incidence of lower back pain are typical for people with unilateral lower limb amputation. A common therapeutic objective is to improve gait symmetry; however, it is unknown whether better gait symmetry reduces lower back pain risk. To begin investigating this important clinical question, we examined a preexisting dataset to explore whether L5/S1 vertebral joint forces in people with unilateral lower limb amputation can be improved with better symmetry. METHODS L5/S1 compression and resultant shear forces were estimated in each participant with unilateral lower limb amputation (n = 5) with an OpenSim musculoskeletal model during different levels of guided gait asymmetry. The amount of gait asymmetry was defined by bilateral stance times and guided via real-time feedback. A theoretical lowest L5/S1 force was determined from the minimum of a best-fit quadratic curves of L5/S1 forces at levels of guided asymmetry ranging from -10 to +15%. The forces found at the theoretical lowest force and during the 0% asymmetry level were compared to forces at preferred levels of asymmetry and to those from an able-bodied group (n = 5). FINDINGS Results indicated that the forces for the people with unilateral lower limb amputation group at the preferred level of asymmetry were not different then at their 0% asymmetry condition, theoretical lowest L5/S1 forces, or the able-bodied group (all p-values > .23). INTERPRETATION These preliminary results challenge the premise that restoring symmetric gait in people with unilateral lower limb amputation will reduce risk of lower back pain.
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Affiliation(s)
- Jacob J Banks
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; Department of Orthopedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue Boston, MA 02215, United States.
| | - Ryan D Wedge
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; Department of Physical Therapy, East Carolina University, Health Sciences Building 600 Moye Blvd, Greenville, NC 27834, United States.
| | - Graham E Caldwell
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States.
| | - Brian R Umberger
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; School of Kinesiology, University of Michigan, 830 North University, Ann Arbor, MI 48109, United States.
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11
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Wedge RD, Sup FC, Umberger BR. Metabolic cost of transport and stance time asymmetry in individuals with unilateral transtibial amputation using a passive prostheses while walking. Clin Biomech (Bristol, Avon) 2022; 94:105632. [PMID: 35364403 DOI: 10.1016/j.clinbiomech.2022.105632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with unilateral amputation typically walk with greater metabolic cost than able-bodied individuals, while preferring asymmetric walking characteristics. It is unclear if asymmetric walking is energetically optimal and how metabolic cost accounts for asymmetric patterns in people with amputation. The purpose of this study was to determine the effects of stance-time asymmetry on the metabolic cost of transport. METHODS Fourteen participants (seven with amputation) completed two laboratory sessions where they walked on a treadmill while receiving real-time visual feedback about stance-time asymmetry. Expired gases were collected to determine the metabolic cost for a range of asymmetries (-15% to +15% in 5% increments, positive percentages represent more time on intact [dominant] limb). FINDINGS Participants with amputation walked with greater (P = 0.008) stance-time asymmetry (4.34 ± 1.09%) compared with able-bodied participants (0.94 ± 2.44%). Stance-time asymmetry had a significant effect on metabolic cost (P < 0.001). The asymmetries coinciding with the predicted minimum metabolic cost for people with (3.23 ± 2.90%) and without (1.81 ± 2.18%) amputation were not different from preferred asymmetries (P = 0.365; p = 0.513), respectively. The cost of symmetric walking was 13.6% greater than near preferred walking for people with amputation (5% more time on intact limb). INTERPRETATION Metabolic cost is not the only objective of walking, but like able-bodied individuals, it may influence how people with amputation walk. Rehabilitation typically tries to restore inter-limb symmetry after an injury, yet if the limbs are asymmetric, symmetric gait may not be optimal with current assistive devices.
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Affiliation(s)
- Ryan D Wedge
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, 110 Totman Building, Amherst, MA 01003-9258, United States; Motion Analysis Laboratory, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT 06518, United States; Department of Physical Therapy, Health Sciences Building, East Carolina University, 600 Moye Blvd, Greenville, NC 27834, United States.
| | - Frank C Sup
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, 120 E Marston Hall, 160 Governor's Drive, Amherst, MA 01003-2210, United States.
| | - Brian R Umberger
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, 110 Totman Building, Amherst, MA 01003-9258, United States; School of Kinesiology, University of Michigan, SKB 1210, 830 North University, Ann Arbor, MI 48109-1048, United States.
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12
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Persine S, Leteneur S, Gillet C, Bassement J, Charlaté F, Simoneau-Buessinger E. Walking abilities improvements are associated with pelvis and trunk kinematic adaptations in transfemoral amputees after rehabilitation. Clin Biomech (Bristol, Avon) 2022; 94:105619. [PMID: 35306365 DOI: 10.1016/j.clinbiomech.2022.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rehabilitation can be proposed to transfemoral amputees to improve functional abilities and limit the risk of early degeneration of the musculoskeletal system partly due to altered kinematic behavior. The main aim of this study was to assess the impact of functional rehabilitation on clinical walking tests, gait symmetry and pelvis and trunk kinematics in transfemoral amputees during overground walking. METHODS Eleven transfemoral amputees followed a functional rehabilitation program with objectives aimed at improving walking abilities and gait symmetry. Clinical functional tests, symmetry between prosthetic and intact sides and trunk and pelvis motions were recorded before and after rehabilitation. FINDINGS Clinical walking tests were improved after rehabilitation (p < 0.05), and step width was reduced (p = 0.04). Regarding symmetry between the single stances on the prosthesis and intact sides, only a significant decrease in trunk frontal inclination asymmetry was noted after rehabilitation (p = 0.01). Pelvic frontal obliquity was significantly increased during prosthetic (p = 0.02) and intact single stances (p = 0.005). INTERPRETATION Our study showed a positive effect of rehabilitation on transfemoral amputees functional abilities. These improvements were associated with higher pelvic mobility in frontal plane and a more symmetrical redistribution of the frontal trunk sway around the vertical axis during gait. These results suggest the importance of a postural reeducation program for transfemoral amputees aimed at improving pelvic dynamic control while repositioning the trunk by postural corrections during gait.
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Affiliation(s)
- S Persine
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | - S Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - C Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - J Bassement
- Centre Hospitalier de Valenciennes, Valenciennes, France
| | - F Charlaté
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France
| | - E Simoneau-Buessinger
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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13
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Wasser JG, Acasio JC, Miller RH, Hendershot BD. Lumbopelvic coordination while walking in service members with unilateral lower limb loss: Comparing variabilities derived from vector coding and continuous relative phase. Gait Posture 2022; 92:284-289. [PMID: 34896840 DOI: 10.1016/j.gaitpost.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Continuous relative phase and vector coding are two common approaches for quantifying lumbopelvic coordination and variability. Evaluating the application of such methodologies to the lower limb loss population is important for better understanding reported asymmetrical movement dynamics of the lumbopelvic region. RESEARCH QUESTION How do coordination variabilities derived from trunk-pelvic coupling angles and continuous relative phases compare among individuals with and without unilateral lower limb loss walking at self-selected speeds? METHODS Full-body kinematics were obtained from thirty-eight males with unilateral lower limb loss (23 transtibial and 15 transfemoral) and fifteen males without limb loss while walking along a 15 m walkway. Coordination variabilities were derived from trunk-pelvic coupling angles and continuous relative phases and compared using a multivariate approach, as well as in unilateral outcome measures between control participants and participants with lower limb loss. RESULTS Overall, tri-planar measures of continuous relative phase variability were 19-43% larger compared to coupling angle variabilities for individuals without limb loss and individuals with transtibial limb loss. Individuals with transfemoral limb loss had 27% and 31% larger sagittal and transverse variabilities from continuous relative phases compared to coupling angles, respectively. During both prosthetic and intact limb stance, individuals with transtibial limb loss had 19-35% greater tri-planar measures of continuous relative phase variability compared to coupling angle variabilities. During intact stance phase, tri-planar measures of continuous relative phase variability were 27%- 42% larger compared to coupling angle variabilities for individuals without limb loss. SIGNIFICANCE While both methods provide valid estimates of lumbopelvic movement variability during gait, continuous relative phase variability may provide a more sensitive estimate in the lower limb loss population capturing velocity-specific motions of the trunk and pelvis.
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Affiliation(s)
- Joseph G Wasser
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda 20814, USA; Henry M. Jackson Foundation, for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda 20817, USA.
| | - Julian C Acasio
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda 20814, USA; Henry M. Jackson Foundation, for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda 20817, USA.
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, 2351 SPH Building, 4200 Valley Dr, College Park 20742, USA; Neuroscience & Cognitive Science Program, University of Maryland, College Park, USA.
| | - Brad D Hendershot
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda 20814, USA; DoD-VA Extremity Trauma & Amputation Center of Excellence, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda 20814, USA.
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Use of a Single Wearable Sensor to Evaluate the Effects of Gait and Pelvis Asymmetries on the Components of the Timed Up and Go Test, in Persons with Unilateral Lower Limb Amputation. SENSORS 2021; 22:s22010095. [PMID: 35009638 PMCID: PMC8747521 DOI: 10.3390/s22010095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
The Timed Up and Go (TUG) test quantifies physical mobility by measuring the total performance time. In this study, we quantified the single TUG subcomponents and, for the first time, explored the effects of gait cycle and pelvis asymmetries on them. Transfemoral (TF) and transtibial (TT) amputees were compared with a control group. A single wearable inertial sensor, applied to the back, captured kinematic data from the body and pelvis during the 10-m walk test and the TUG test. From these data, two categories of symmetry indexes (SI) were computed: One SI captured the differences between the antero-posterior accelerations of the two sides during the gait cycle, while another set of SI quantified the symmetry over the three-dimensional pelvis motions. Moreover, the total time of the TUG test, the time of each subcomponent, and the velocity of the turning subcomponents were measured. Only the TF amputees showed significant reductions in each SI category when compared to the controls. During the TUG test, the TF group showed a longer duration and velocity reduction mainly over the turning subtasks. However, for all the amputees there were significant correlations between the level of asymmetries and the velocity during the turning tasks. Overall, gait cycle and pelvis asymmetries had a specific detrimental effect on the turning performance instead of on linear walking.
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Kolářová B, Janura M, Svoboda Z, Kolář P, Tečová D, Elfmark M. Postural Control Strategies and Balance-Related Factors in Individuals with Traumatic Transtibial Amputations. SENSORS 2021; 21:s21217284. [PMID: 34770589 PMCID: PMC8587115 DOI: 10.3390/s21217284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/18/2023]
Abstract
Mechanisms behind compromised balance control in people with transtibial amputation need to be further explored, as currently little is known specifically about postural control strategies in people with traumatic transtibial amputation (tTTA). The aim of this study is to assess automatic and voluntary postural control strategies in individuals with unilateral tTTA compared to those in control subjects and to define the effect of balance-related factors on these strategies. Automatic posture reactions and volitional motion toward given direction using standardized posturographic protocols (NeuroCom) of the Motor Control Test (MCT) and Limits of Stability (LOS) were assessed in eighteen participants with tTTA and eighteen age-matched controls. Compared to the controls, the participants with tTTA bore less weight on the prosthetic leg (p < 0.001) during the MCT and had reduced inclination toward the prosthetic leg (p < 0.001) within the LOS. In the tTTA group, the weight-bearing symmetry and the inclination toward the prosthetic leg (p < 0.05) was positively correlated with prosthesis use duration (p < 0.05). The current study indicates that decreased utilization of the prosthetic leg in tTTAs represents adaptive postural control strategy, but as prosthesis use duration increased, the engagement of the prosthetic leg improved.
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Affiliation(s)
- Barbora Kolářová
- Kinesiology Laboratory, Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic;
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
- Correspondence:
| | - Miroslav Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
| | - Zdeněk Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
| | - Petr Kolář
- Kinesiology Laboratory, Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic;
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
| | - Dagmar Tečová
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
| | - Milan Elfmark
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
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Overall Greater Demands on the Musculoskeletal System at Multiple Walking Speeds in Service Members With Lower Limb Loss. J Appl Biomech 2021; 37:522-530. [PMID: 34689127 DOI: 10.1123/jab.2020-0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022]
Abstract
Individuals with lower limb loss often walk with altered/asymmetric movement mechanics, postulated as a catalyst for development of low back and knee pain. Here, the authors simultaneously investigated trunk-pelvic movement patterns and lower limb joint kinematics and kinetics among 38 males with traumatic, unilateral lower limb loss (23 transtibial and 15 transfemoral), and 15 males without limb loss, at a self-selected and 2 standardized (1.0 and 1.6 m/s) speeds. Individuals with versus without lower limb loss walked with greater trunk range of motion in the frontal and transverse planes at all speeds (despite ∼10% slower self-selected speeds). At all speeds, individuals with versus without limb loss exhibited +29% larger medial ground reaction forces, and at 1.6 m/s also exhibited +50% to 110% larger vertical hip power generation, +27% to 80% larger vertical hip power absorption, and +21% to 90% larger medial-lateral hip power absorption. Moreover, pervasive biomechanical differences between transtibial versus transfemoral limb loss identify amputation-level movement strategies. Overall, greater demands on the musculoskeletal system across walking speeds, particularly at the hip, knee, and low back, highlight potential risk factors for the development/recurrence of prevalent secondary musculoskeletal conditions (eg, joint degeneration and pain) following limb loss.
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17
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Sibley AR, Strike S, Moudy SC, Tillin NA. The associations between asymmetries in quadriceps strength and gait in individuals with unilateral transtibial amputation. Gait Posture 2021; 90:267-273. [PMID: 34536691 DOI: 10.1016/j.gaitpost.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with unilateral transtibial amputations (ITTAs) are asymmetrical in quadriceps strength. It is unknown if this is associated with gait performance characteristics such as walking speed and limb symmetry. RESEARCH QUESTION Are quadriceps strength asymmetries related to walking speed and/ or gait asymmetries in ITTAs? METHODS Knee-extensor isometric maximum voluntary torque (MVT) and rate of torque development (RTD) were measured in eight ITTAs. Gait data were captured as the ITTAs walked at self-selected habitual and fast speeds. Step length and single support time, peak knee extension moments and their impulse and peak vertical ground reaction force (vGRF) in the braking and propulsive phases of stance were extracted. Bilateral Asymmetry Index (BAI) and, for gait variables only, difference in BAI between walking speeds (ΔBAI) were calculated. Correlation analyses assessed the relationships between MVT and RTD asymmetry and (1) walking speed; (2) gait asymmetries. RESULTS Associations between strength and gait BAIs generally became more apparent at faster walking speeds, and when the difference in BAI between fast and habitual walking speed was considered. BAI RTD was strongly negatively correlated with habitual and fast walking speeds (r=∼0.83). Larger BAI RTD was strongly correlated with propulsive vGRF BAI in fast walking, and larger ΔBAIs in vGRF during both the braking and propulsion phases of gait (r = 0.74-0.92). ITTAs who exhibited greater BAI MVT showed greater ΔBAI in single support time (r = 0.83). SIGNIFICANCE While MVT and RTD BAI appear to be associated with gait asymmetries in ITTAs, the magnitude of the asymmetry in RTD appears to be a more sensitive marker of walking speed. Based on these results, it's possible that strengthening the knee-extensors of the amputated limb to improve both MVT and RTD symmetry may benefit walking speed, and reduce asymmetrical loading in gait.
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Affiliation(s)
- Amy R Sibley
- Department of Life Sciences, Whitelands College, University of Roehampton, Holybourne Avenue, London, SW15 4JD, UK.
| | - Siobhán Strike
- Department of Life Sciences, Whitelands College, University of Roehampton, Holybourne Avenue, London, SW15 4JD, UK.
| | - Sarah C Moudy
- Department of Life Sciences, Whitelands College, University of Roehampton, Holybourne Avenue, London, SW15 4JD, UK.
| | - Neale A Tillin
- Department of Life Sciences, Whitelands College, University of Roehampton, Holybourne Avenue, London, SW15 4JD, UK.
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Watson F, Fino PC, Thornton M, Heracleous C, Loureiro R, Leong JJH. Use of the margin of stability to quantify stability in pathologic gait - a qualitative systematic review. BMC Musculoskelet Disord 2021; 22:597. [PMID: 34182955 PMCID: PMC8240253 DOI: 10.1186/s12891-021-04466-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Margin of Stability (MoS) is a widely used objective measure of dynamic stability during gait. Increasingly, researchers are using the MoS to assess the stability of pathological populations to gauge their stability capabilities and coping strategies, or as an objective marker of outcome, response to treatment or disease progression. The objectives are; to describe the types of pathological gait that are assessed using the MoS, to examine the methods used to assess MoS and to examine the way the MoS data is presented and interpreted. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) in the following databases: Web of Science, PubMed, UCL Library Explore, Cochrane Library, Scopus. All articles measured the MoS of a pathologically affected adult human population whilst walking in a straight line. Extracted data were collected per a prospectively defined list, which included: population type, method of data analysis and model building, walking tasks undertaken, and interpretation of the MoS. RESULTS Thirty-one studies were included in the final review. More than 15 different clinical populations were studied, most commonly post-stroke and unilateral transtibial amputee populations. Most participants were assessed in a gait laboratory using motion capture technology, whilst 2 studies used instrumented shoes. A variety of centre of mass, base of support and MoS definitions and calculations were described. CONCLUSIONS This is the first systematic review to assess use of the MoS and the first to consider its clinical application. Findings suggest the MoS has potential to be a helpful, objective measurement in a variety of clinically affected populations. Unfortunately, the methodology and interpretation varies, which hinders subsequent study comparisons. A lack of baseline results from large studies mean direct comparison between studies is difficult and strong conclusions are hard to make. Further work from the biomechanics community to develop reporting guidelines for MoS calculation methodology and a commitment to larger baseline studies for each pathology is welcomed.
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Affiliation(s)
- Fraje Watson
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT, 84112, USA
| | - Matthew Thornton
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Constantinos Heracleous
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Rui Loureiro
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Julian J H Leong
- University College London, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Syrett ED, Peterson CL, Darter BJ. Assessing the effects of gait asymmetry: Using a split-belt treadmill walking protocol to change step length and peak knee joint contact force symmetry. J Biomech 2021; 125:110583. [PMID: 34198019 DOI: 10.1016/j.jbiomech.2021.110583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022]
Abstract
Asymmetrical gait may affect important outcomes such as knee joint contact force (KJCF). A split-belt treadmill (SBTM) can be used to provoke changes in step length symmetry (SLsym) and may produce a similar response in KJCF symmetry (KJCFsym) between limbs. The purpose of this study was to explore the utility of employing a SBTM walking paradigm to alter KJCF and KJCFsym and to determine if changes in SLsym coincided with changes in KJCFsym. Twenty healthy individuals performed a standardized SBTM protocol, where baseline and post-adaptation conditions had tied belt speeds of 0.5 m/s and the split-adaptation condition used a 3:1 belt speed ratio. OpenSim techniques were used to produce normalized, averaged stance phase peak KJCF during baseline walking, early- and late-adaptation, and post-adaptation. SLsym and KJCFsym values were determined. Comparisons were made for symmetry values between early- and late-adaptation and between baseline and post-adaptation. SLsym and KJCFsym did not respond in the same manner during the walking conditions. While step lengths (SL) were asymmetric during early adaptation but become more symmetric by late adaptation (p < 0.01), KJCF was symmetric throughout adaptation. Conversely, SL and KJCF exhibited similar responses during the baseline and post-adaptation conditions, with symmetry at baseline and asymmetry during post-adaptation (p < 0.01). In the post-adaptation condition, higher peak forces were demonstrated on the limb taking a shorter step. Results suggest a SBTM program may alter KJCF and KJCFsym between limbs. Furthermore, a comparison between baseline and post-adaptation may be more appropriate for evaluating the relationship between SL and KJCF.
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Affiliation(s)
- E Daniel Syrett
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Carrie L Peterson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Research, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA 23249, USA.
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Kaufman KR, Bernhardt K. Functional performance differences between carbon fiber and fiberglass prosthetic feet. Prosthet Orthot Int 2021; 45:205-213. [PMID: 33856155 DOI: 10.1097/pxr.0000000000000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with lower limb amputation require increased functionality. The largest category of feet for active individuals with a transtibial amputation is energy storage and return (ESR) feet. These feet are typically constructed of carbon fiber composite materials. Recently, a prosthetic foot composed of a fiberglass composite has emerged in the market. However, there are no comparative studies of these devices. OBJECTIVES Compare the biomechanical performance and prosthesis-related quality of life when using a fiberglass prosthetic foot design compared with traditional carbon fiber ESR designs. STUDY DESIGN This is a repeated-measures randomized cross-over trial. METHODS Gait analysis was performed on 10 experienced male subjects with unilateral transtibial amputations (K-level III) while walking on level ground and a ramp. Patient-reported outcomes were collected using the Prosthesis Evaluation Questionnaire. RESULTS Gait data demonstrated increased ankle dorsiflexion (P < .01), similar ankle moments (P = .07), and increased ankle power generation (P = .01) when using the fiberglass foot. The increased power generation occurred at the correct time in the gait cycle such that the timing and magnitude of peak knee flexion was unaffected (P > .19). The fiberglass foot had greater energy absorption during gait (P = .01) with no difference in energy return (P = .37). The subjects expressed improved prosthesis-related quality of life with the fiberglass foot (P = .01). CONCLUSIONS The findings of this study demonstrate that the new ESR foot comprising a fiberglass material had better performance than traditional designs using a carbon fiber material.
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Affiliation(s)
- Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Simonetti E, Bergamini E, Vannozzi G, Bascou J, Pillet H. Estimation of 3D Body Center of Mass Acceleration and Instantaneous Velocity from a Wearable Inertial Sensor Network in Transfemoral Amputee Gait: A Case Study. SENSORS (BASEL, SWITZERLAND) 2021; 21:3129. [PMID: 33946325 PMCID: PMC8125485 DOI: 10.3390/s21093129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/04/2022]
Abstract
The analysis of the body center of mass (BCoM) 3D kinematics provides insights on crucial aspects of locomotion, especially in populations with gait impairment such as people with amputation. In this paper, a wearable framework based on the use of different magneto-inertial measurement unit (MIMU) networks is proposed to obtain both BCoM acceleration and velocity. The proposed framework was validated as a proof of concept in one transfemoral amputee against data from force plates (acceleration) and an optoelectronic system (acceleration and velocity). The impact in terms of estimation accuracy when using a sensor network rather than a single MIMU at trunk level was also investigated. The estimated velocity and acceleration reached a strong agreement (ρ > 0.89) and good accuracy compared to reference data (normalized root mean square error (NRMSE) < 13.7%) in the anteroposterior and vertical directions when using three MIMUs on the trunk and both shanks and in all three directions when adding MIMUs on both thighs (ρ > 0.89, NRMSE ≤ 14.0% in the mediolateral direction). Conversely, only the vertical component of the BCoM kinematics was accurately captured when considering a single MIMU. These results suggest that inertial sensor networks may represent a valid alternative to laboratory-based instruments for 3D BCoM kinematics quantification in lower-limb amputees.
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Affiliation(s)
- Emeline Simonetti
- INI/CERAH, 47 Rue de l’Echat, 94000 Créteil, France;
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, 151 Boulevard de l’Hôpital, 75013 Paris, France;
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (E.B.); (G.V.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (E.B.); (G.V.)
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza Lauro de Bosis 15, 00135 Roma, Italy; (E.B.); (G.V.)
| | - Joseph Bascou
- INI/CERAH, 47 Rue de l’Echat, 94000 Créteil, France;
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, 151 Boulevard de l’Hôpital, 75013 Paris, France;
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, 151 Boulevard de l’Hôpital, 75013 Paris, France;
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22
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Bahari H, Forero J, Hall JC, Hebert JS, Vette AH, Rouhani H. Use of the extended feasible stability region for assessing stability of perturbed walking. Sci Rep 2021; 11:1026. [PMID: 33441817 PMCID: PMC7807089 DOI: 10.1038/s41598-020-79955-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
Walking stability has been assessed through gait variability or existing biomechanical measures. However, such measures are unable to quantify the instantaneous risk of loss-of-balance as a function of gait parameters, body sway, and physiological and perturbation conditions. This study aimed to introduce and evaluate novel biomechanical measures for loss-of-balance under various perturbed walking conditions. We introduced the concept of ‘Extended Feasible Stability Region (ExFSR)’ that characterizes walking stability for the duration of an entire step. We proposed novel stability measures based on the proximity of the body’s centre of mass (COM) position and velocity to the ExFSR limits. We quantified perturbed walking of fifteen non-disabled individuals and three individuals with a disability, and calculated our proposed ExFSR-based measures. 17.2% (32.5%) and 26.3% (34.0%) of the measured trajectories of the COM position and velocity during low (high) perturbations went outside the ExFSR limits, for non-disabled and disabled individuals, respectively. Besides, our proposed measures significantly correlated with measures previously suggested in the literature to assess gait stability, indicating a similar trend in gait stability revealed by them. The ExFSR-based measures facilitate our understanding on the biomechanical mechanisms of loss-of-balance and can contribute to the development of strategies for balance assessment.
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Affiliation(s)
- Hosein Bahari
- Department of Mechanical Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.,Glenrose Rehabilitation Hospital, Alberta Health Services, 10230-111 Avenue NW, Edmonton, AB, T5G 0B7, Canada
| | - Juan Forero
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230-111 Avenue NW, Edmonton, AB, T5G 0B7, Canada
| | - Jeremy C Hall
- Department of Mechanical Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Jacqueline S Hebert
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230-111 Avenue NW, Edmonton, AB, T5G 0B7, Canada.,Faculty of Medicine and Dentistry, Katz Group Centre, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.,Glenrose Rehabilitation Hospital, Alberta Health Services, 10230-111 Avenue NW, Edmonton, AB, T5G 0B7, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada. .,Glenrose Rehabilitation Hospital, Alberta Health Services, 10230-111 Avenue NW, Edmonton, AB, T5G 0B7, Canada.
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23
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Mahon CE, Darter BJ, Dearth CL, Hendershot BD. The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study. Mil Med 2020; 184:e281-e287. [PMID: 30690459 DOI: 10.1093/milmed/usy424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/13/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation. MATERIALS AND METHODS The relationship between temporal-spatial gait asymmetry and metabolic economy (metabolic power normalized by walking speed) was retrospectively examined in eighteen individuals with transfemoral amputation walking at a self-selected velocity overground. Pearson's product-moment correlations were used to assess the relationship between: (1) step time symmetry and metabolic economy and (2) step length symmetry and metabolic economy. The retrospective analysis of this data was approved by the Walter Reed National Military Medical Center Institutional Review Board and all individuals provided written consent. Additional insights on this relationship are presented through a case series describing the temporal-spatial and metabolic responses of two individuals with transfemoral amputation who completed a split-belt treadmill walking test. RESULTS For the cohort of individuals, there was no significant relationship between metabolic economy and either step time asymmetry or step length asymmetry. However, the case series showed a positive relationship between step length asymmetry and metabolic power as participants adapted to split-belt treadmill walking. CONCLUSION There is mixed evidence for the relationship between temporal-spatial asymmetries and metabolic energy expenditure. This preliminary study may suggest optimal metabolic energy expenditure in individuals with transfemoral amputation occurs at an individualized level of symmetry and resultant deviations incur a metabolic penalty. The results of this study support the idea that addressing only temporal-spatial gait asymmetries in individuals with transfemoral amputation through rehabilitation may not improve metabolic economy. Nevertheless, future prospective research is necessary to confirm these results and implications for clinical practice.
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Affiliation(s)
- Caitlin E Mahon
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD
| | - Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, 1200 E. Broad St., Box 980224, Richmond, VA.,Department of Physical Medicine & Rehabilitation, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd., Richmond, VA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Surgery, Uniformed Services University of the Health Sciences & Walter Reed National Military Medical Center, Bethesda, MD
| | - Brad D Hendershot
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
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24
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Step length symmetry adaptation to split-belt treadmill walking after acquired non-traumatic transtibial amputation. Gait Posture 2020; 80:162-167. [PMID: 32516682 PMCID: PMC7369240 DOI: 10.1016/j.gaitpost.2020.05.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. However, individuals with non-traumatic TTA have critical health-related impairments that may influence the ability to respond to split-belt treadmill walking. RESEARCH QUESTION Do people with acquired, non-traumatic TTA adapt and retain a more symmetrical gait pattern in response to split-belt treadmill walking? METHODS Step length asymmetry was measured during split-belt treadmill walking. Eight participants walked under two alternating belt speed conditions: symmetrical (3 sets; Baseline, TIED1, TIED2) and asymmetrical belt speeds (5 sets; SPLIT1-5). One-way repeated-measures ANOVA with post-hoc Tukey's HSD tests were used to assess adaptation and short-term retention of step length symmetry. Adaptation was assessed as the level of asymmetry during TIED walking following repeated exposure to SPLIT walking. Retention was measured as the change in level of asymmetry during each set of SPLIT walking. RESULTS Significant adaptation to split-belt walking was observed from late Baseline to early TIED1 and early TIED2. Between-limb step length asymmetry decreased from late Baseline (5.3 ± 3.4) to early TIED1 (-9.4 ± 3.6) and this change was sustained between early TIED1 and early TIED2 (-11.2 ± 3.1) (ANOVA F = 73.043, p < .001). Adaptations were retained as step length asymmetry decreased from early SPLIT1 (48.5 ± 5.3) to early SPLIT3 (31.4 ± 3.5) to early SPLIT5 (23.9 ± 5.1) (ANOVA F = 35.284, p < .001). SIGNIFICANCE Individuals with non-traumatic TTA are capable of gait adaptation to split-belt walking and short-term retention of adaptations after removal of the asymmetrical belt speeds. Adaptability of step length symmetry is possible without modification to the prosthetic limb. Split-belt walking should be tested as a potential intervention to help people with acquired, non-traumatic TTA increase between-limb step symmetry.
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25
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Foster RJ, Haley MR, Talbot IW, De Asha AR, Barnett CT. Individuals with unilateral transtibial amputation exhibit reduced accuracy and precision during a targeted stepping task. J Biomech 2020; 105:109785. [PMID: 32331853 DOI: 10.1016/j.jbiomech.2020.109785] [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: 08/30/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
Accurate foot placement is important for dynamic balance during activities of daily living. Disruption of sensory information and prosthetic componentry characteristics may result in increased locomotor task difficulty for individuals with lower limb amputation. This study investigated the accuracy and precision of prosthetic and intact foot placement during a targeted stepping task in individuals with unilateral transtibial amputation (IUTAs; N = 8, 47 ± 13 yrs), compared to the preferred foot of control participant's (N = 8, 33 ± 15 yrs). Participants walked along a 10-metre walkway, placing their foot into a rectangular floor-based target with dimensions normalised to a percentage of participant's foot length and width; 'standard' = 150% x 150%, 'wide' = 150% x 200%, 'long' = 200% x 150%. Foot placement accuracy (relative distance between foot and target centre), precision (between-trial variability), and foot-reach kinematics were determined for each limb and target, using three-dimensional motion capture. A significant foot-by-target interaction revealed less mediolateral foot placement accuracy for IUTAs in the wide target, which was significantly less accurate for the intact (28 ± 12 mm) compared to prosthetic foot (16 ± 14 mm). Intact peak foot velocity (4.6 ± 0.8 m.s-1) was greater than the prosthetic foot (4.5 ± 0.8 m.s-1) for all targets. Controls were more accurate and precise than IUTAs, regardless of target size. Less accurate and precise intact foot placement in IUTAs, coupled with a faster moving intact limb, is likely due to several factors including reduced proprioceptive feedback and active control during prosthetic limb single stance. This could affect activities of daily living where foot placement is critical, such as negotiating cluttered travel paths or obstacles whilst maintaining balance.
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Affiliation(s)
- R J Foster
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Byrom Street, Liverpool John Moores University, Liverpool L3 3AF, UK.
| | - M R Haley
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Byrom Street, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - I W Talbot
- Pace Rehabilitation Limited, 7 Bredbury Park Way, Bredbury, Stockport, Cheshire SK6 2SN, UK
| | - A R De Asha
- C-Motion, Inc., 20030 Century Blvd, Suite 104A Germantown, MD 20874 USA; School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NF, UK
| | - C T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NF, UK
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26
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Inertial sensor-based measures of gait symmetry and repeatability in people with unilateral lower limb amputation. Clin Biomech (Bristol, Avon) 2020; 72:102-107. [PMID: 31862603 DOI: 10.1016/j.clinbiomech.2019.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/03/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with lower limb amputation often walk with asymmetrical gait patterns potentially leading to long-term health problems, ultimately affecting their quality of life. The ability to discreetly detect and quantify the movement of bilateral thighs and shanks using wearable sensor technology can provide additional insight into how a person walks with a lower limb prosthesis. This study investigated segmental symmetry and segmental repeatability of people with unilateral lower limb amputation, examining performance of the prosthetic and intact limbs. METHODS Gyroscope signals were recorded from four inertial measurement units worn on bilateral lower limb segments of subjects with unilateral lower limb amputation during the 10-m walk test. Raw angular velocity signals were processed using dynamic time warping and application of algorithms resulting in symmetry measures comparing similarity of prosthetic to intact limb strides, and repeatability measures comparing movement of one limb to its consecutive strides. FINDINGS Biomechanical differences in performance of the prosthetic and intact limb segments were detected with the segmental symmetry and segmental repeatability measures in 128 subjects. More asymmetries and less consistent movements of the lower limbs were exhibited by subjects with transfemoral amputation versus transtibial amputation (p < .004, Cohen's d = 0.65-1.1). INTERPRETATION Sensor-based measures of segmental symmetry and segmental repeatability were found to be reliable in detecting discreet differences in movement of the prosthetic versus intact lower limbs in amputee subjects. These measures provide a convenient tool for enhanced prosthetic gait analysis with the potential to focus rehabilitative and prosthetic interventions.
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27
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A Mechanical Descriptor of Instability in Human Locomotion: Experimental Findings in Control Subjects and People with Transfemoral Amputation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030840] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While multiple criteria to quantify gait instability exist, some limitations hinder their computation during realistic walking conditions. A descriptor, computed as the distance between the center of mass of the body and the minimal moment axis ( d C O M − Δ ) , has been proposed recently. This present study aims at characterizing the behavior of the mentioned descriptor in a population at a higher risk of falls. Five individuals with transfemoral amputation and 14 healthy individuals were involved in an experiment composed of motion capture and force plates acquisition during overground walking at a self-selected speed. For both groups of participants, the profile of d C O M − Δ was analyzed and descriptive parameters were calculated. The plot of d C O M − Δ was different between groups and different relative to the leading limb considered (prosthetic or contralateral). All descriptive parameters calculated, except one, were statistically different between groups. As a conclusion, amputees seem to be able to limit the average of d C O M − Δ in spite of a different evolution pattern. This is consistent with the ability of the subjects to maintain their dynamic balance. However, the extracted parameters showed the significant asymmetry of the gait profile between prosthetic and contralateral stances and highlighted the potential sources of imbalance.
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28
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Leijendekkers RA, Hoogeboom TJ, van Hinte G, Didden L, Anijs T, Nijhuis-van der Sanden MWG, Verdonschot N. Reproducibility and discriminant validity of two clinically feasible measurement methods to obtain coronal plane gait kinematics in participants with a lower extremity amputation. PLoS One 2019; 14:e0217046. [PMID: 31112589 PMCID: PMC6528991 DOI: 10.1371/journal.pone.0217046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/03/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Measuring coronal plane gait kinematics of the pelvis and trunk during rehabilitation of participants with a lower extremity amputation is important to detect asymmetries in gait which are hypothesised as associated with secondary complaints. The aim of this study was to test the reproducibility and discriminant validity of a three-dimensional (3-D; inertial measurement units) and a two-dimensional (2-D; video-based) system. Methods We tested the test-retest and inter-rater reproducibility of both systems and the 2-D system, respectively, in participants with a lower extremity amputation (group 1) and healthy subjects (group 2). The discriminant validity was determined with a within-group comparison for the 3-D system and with a between-group comparison for both systems. Results Both system showed to be test-retest reliable, both in group 1 (2-D system: ICC3.1agreement 0.52–0.83; 3-D system: ICC3.1agreement 0.81–0.95) and in group 2 (3-D system: ICC3.1agreement 0.33–0.92; 2-D system: ICC3.1agreement 0.54–0.95). The 2-D system was also inter-rater reliable (group 1: ICC2.1agreement 0.80–0.92; group 2: ICC2.1agreement 0.39–0.90). The within-group comparison of the 3-D system revealed a statistically significant asymmetry of 0.4°-0.5° in group 1 and no statistically significant asymmetry in group 2. The between-group comparison revealed that the maximum amplitude towards the residual limb (MARL) in the low back (3-D system) and the (residual) limb—trunk angle (2-D system) were significantly larger with a mean difference of 1.2° and 6.4°, respectively, than the maximum amplitude of healthy subjects. However, these average differences were smaller than the smallest detectable change (SDC) of group 1 for both the MARL (SDCagreement: 1.5°) and the residual limb—trunk angle (SDCagreement: 6.7°-7.6°). Conclusion The 3-D and 2-D systems tested in this study were not sensitive enough to detect real differences within and between participants with a lower extremity amputation and healthy subjects although promising reproducibility parameters for some of the outcome measures.
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Affiliation(s)
- Ruud A. Leijendekkers
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
- * E-mail:
| | - Thomas J. Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerben van Hinte
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lars Didden
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thomas Anijs
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
- Laboratory for Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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Chiu VL, Voloshina AS, Collins SH. An Ankle-Foot Prosthesis Emulator Capable of Modulating Center of Pressure. IEEE Trans Biomed Eng 2019; 67:166-176. [PMID: 30969914 DOI: 10.1109/tbme.2019.2910071] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Several powered ankle-foot prostheses have demonstrated moderate reductions in energy expenditure by restoring pushoff work in late stance or by assisting with balance. However, it is possible that center of pressure trajectory modulation could provide even further improvements in user performance. Here, we describe the design of a prosthesis emulator with two torque-controlled forefoot digits and a torque-controlled heel digit. Independent actuation of these three digits can modulate the origin and magnitude of the total ground reaction force vector. METHODS The emulator was designed to be compact and lightweight while exceeding the range of motion and torque requirements of the biological ankle during walking. We ran a series of tests to determine torque-measurement accuracy, closed-loop torque control bandwidth, torque-tracking error, and center of pressure control accuracy. RESULTS Each of the three digits demonstrated less than 2 Nm of RMS torque measurement error, a 90% rise time of 19 ms, and a bandwidth of 33 Hz. The untethered end-effector has a mass of 1.2 kg. During walking trials, the emulator demonstrated less than 2 Nm of RMS torque-tracking error and was able to maintain full digit ground contact for 56% of stance. In fixed, standing, and walking conditions, the emulator was able to control center of pressure along a prescribed pattern with RMS errors of about 10% the length of the pattern. CONCLUSION The proposed emulator system meets all design criteria and can effectively modulate center of pressure and ground reaction force magnitude. SIGNIFICANCE This emulator system will enable rapid development of controllers designed to enhance user balance and reduce user energy expenditure. Experiments conducted using this emulator could identify beneficial control behaviors that can be implemented on autonomous devices, thus improving mobility and quality of life of individuals with amputation.
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30
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Lindemann U. Spatiotemporal gait analysis of older persons in clinical practice and research : Which parameters are relevant? Z Gerontol Geriatr 2019; 53:171-178. [PMID: 30770991 DOI: 10.1007/s00391-019-01520-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
For older persons walking is a basic activity of daily life which characterizes the person's functional mobility. Therefore, the improvement of walking performance is a major clinical outcome during geriatric rehabilitation. Furthermore, walking performance is relevant for several geriatric research issues. Quantitative gait analysis can describe walking performance in detail. Besides gait speed, various qualitative parameters related to different aspects of walking performance, such as symmetry, regularity, coordination, dynamic balance and foot movement during the swing phase, can serve as outcome parameters in geriatric research and in clinical practice. Clinicians and researchers have to decide which parameters are appropriate to be used as relevant outcome parameters in the investigated person or group of persons.
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Affiliation(s)
- Ulrich Lindemann
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
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31
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Pickle NT, Silverman AK, Wilken JM, Fey NP. Statistical analysis of timeseries data reveals changes in 3D segmental coordination of balance in response to prosthetic ankle power on ramps. Sci Rep 2019; 9:1272. [PMID: 30718756 PMCID: PMC6362138 DOI: 10.1038/s41598-018-37581-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022] Open
Abstract
Active ankle-foot prostheses generate mechanical power during the push-off phase of gait, which can offer advantages over passive prostheses. However, these benefits manifest primarily in joint kinetics (e.g., joint work) and energetics (e.g., metabolic cost) rather than balance (whole-body angular momentum, H), and are typically constrained to push-off. The purpose of this study was to analyze differences between active and passive prostheses and non-amputees in coordination of balance throughout gait on ramps. We used Statistical Parametric Mapping (SPM) to analyze time-series contributions of body segments (arms, legs, trunk) to three-dimensional H on uphill, downhill, and level grades. The trunk and prosthetic-side leg contributions to H at toe-off when using the active prosthesis were more similar to non-amputees compared to using a passive prosthesis. However, using either a passive or active prosthesis was different compared to non-amputees in trunk contributions to sagittal-plane H during mid-stance and transverse-plane H at toe-off. The intact side of the body was unaffected by prosthesis type. In contrast to clinical balance assessments (e.g., single-leg standing, functional reach), our analysis identifies significant changes in the mechanics of segmental coordination of balance during specific portions of the gait cycle, providing valuable biofeedback for targeted gait retraining.
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Affiliation(s)
- Nathaniel T Pickle
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, USA
| | - Jason M Wilken
- Center for the Intrepid, Brooke Army Medical Center, JBSA Ft Sam Houston, TX, 78234, USA.,Extremity Trauma and Amputation Center of Excellence, JBSA Ft Sam Houston, TX, 78234, USA
| | - Nicholas P Fey
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, 75080, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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Ho Hoang KL, Wolf SI, Mombaur K. Benchmarking Stability of Bipedal Locomotion Based on Individual Full Body Dynamics and Foot Placement Strategies-Application to Impaired and Unimpaired Walking. Front Robot AI 2018; 5:117. [PMID: 33500996 PMCID: PMC7805904 DOI: 10.3389/frobt.2018.00117] [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: 03/15/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Abstract
The principles underlying smooth and effortless human walking while maintaining stability as well as the ability to quickly respond to unexpected perturbations result from a plethora of well-balanced parameters, most of them yet to be determined. In this paper, we investigate criteria that may be useful for benchmarking stability properties of human walking. We perform dynamic reconstructions of human walking motions of unimpaired subjects and subjects walking with transfemoral prostheses from motion capture recordings using optimal control. We aim at revealing subject-specific strategies in applying dynamics in order to maintain steady gait considering irregularities such as deviating gait patterns or asymmetric body segment properties. We identify foot placement with respect to the Instantaneous Capture Point as the strategy globally applied by the subjects to obtain steady gait and propose the Residual Orbital Energy as a measure allowing for benchmarking human-like gait toward confident vs. cautious gait.
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Affiliation(s)
- Khai-Long Ho Hoang
- Optimization, Robotics and Biomechanics, Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Mombaur
- Optimization, Robotics and Biomechanics, Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
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33
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Houdijk H, Wezenberg D, Hak L, Cutti AG. Energy storing and return prosthetic feet improve step length symmetry while preserving margins of stability in persons with transtibial amputation. J Neuroeng Rehabil 2018; 15:76. [PMID: 30255807 PMCID: PMC6157252 DOI: 10.1186/s12984-018-0404-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Energy storing and return (ESAR) feet are generally preferred over solid ankle cushioned heel (SACH) feet by people with a lower limb amputation. While ESAR feet have been shown to have only limited effect on gait economy, other functional benefits should account for this preference. A simple biomechanical model suggests that enhanced gait stability and gait symmetry could prove to explain part of the difference in the subjective preference between both feet. Aim To investigate whether increased push-off power with ESAR feet increases center of mass velocity at push off and enhance intact step length and step length symmetry while preserving the margin of stability during walking in people with a transtibial prosthesis. Methods Fifteen people with a unilateral transtibial amputation walked with their prescribed ESAR foot and a SACH foot at a fixed walking speed (1.2 m/s) over a level walkway while kinematic and kinetic data were collected. Push-off work generated by the foot, center of mass velocity, step length, step length symmetry and backward margin of stability were assessed and compared between feet. Results Push-off work was significantly higher when using the ESAR foot compared to the SACH foot. Simultaneously, center of mass velocity at toe-off was higher with ESAR compared to SACH, and intact step length and step length symmetry increased without reducing the backward margin of stability. Conclusion Compared to the SACH foot, the ESAR foot allowed an improvement of step length symmetry while preserving the backward margin of stability at community ambulation speed. These benefits may possibly contribute to the subjective preference for ESAR feet in people with a lower limb amputation.
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Affiliation(s)
- Han Houdijk
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands. .,Department of Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
| | - Daphne Wezenberg
- Department of Health & Technology
- Human Kinetic Technology, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Laura Hak
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - Andrea Giovanni Cutti
- Production Directorate, Applied Research, INAIL Prosthesis Center, Vigorso di Budrio, Bologna, Italy
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Darter BJ, Labrecque BA, Perera RA. Dynamic stability during split-belt walking and the relationship with step length symmetry. Gait Posture 2018; 62. [PMID: 29533870 PMCID: PMC5960610 DOI: 10.1016/j.gaitpost.2018.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Walking instability is a contributor to falls and other undesired changes in walking performance. We investigated the effect of split-belt treadmill based perturbations on dynamic stability. Furthermore, we examined the relationships for dynamic stability and symmetry during unperturbed and perturbed walking. METHOD Twenty healthy young adults completed unperturbed and perturbed walking conditions on a split-belt treadmill. The continuous perturbation involved moving the parallel belts at unequal speeds (1.5 m/s: 0.5 m/s). Margins of stability (MoS) and step length symmetry (SYM) were assessed. RESULTS Stability and symmetry measures each decreased at the onset of the split walking perturbation. Only anterior-posterior (AP) MoS and SYM exhibited adaptive changes. Associations were found primarily for AP MoS with immediate changes in SYM at the onset of split walking, and over the duration of the split walking condition. DISCUSSION Our findings suggest walking strategies were adapted to maintain dynamic stability when faced with a continuous perturbation. Additionally, dynamic stability was associated with symmetry during perturbed walking.
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Affiliation(s)
- Benjamin J. Darter
- Department of Physical Therapy, Virginia Commonwealth University,
1200 E. Broad Street, Box 980224, Richmond, VA, 23298 USA,Department of Physical Medicine and Rehabilitation, Hunter Holmes
McGuire Veteran Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, 23249
USA
| | - Bethany A. Labrecque
- Department of Physical Therapy, Virginia Commonwealth University,
1200 E. Broad Street, Box 980224, Richmond, VA, 23298 USA
| | - Robert A. Perera
- Department of Biostatistics, Virginia Commonwealth University, Box
980032, Richmond, VA,23298 USA
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Iosa M, Morone G, Paolucci S. Golden Gait: An Optimization Theory Perspective on Human and Humanoid Walking. Front Neurorobot 2017; 11:69. [PMID: 29311890 PMCID: PMC5742096 DOI: 10.3389/fnbot.2017.00069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/08/2017] [Indexed: 01/02/2023] Open
Abstract
Human walking is a complex task which includes hundreds of muscles, bones and joints working together to deliver harmonic movements with the need of finding equilibrium between moving forward and maintaining stability. Many different computational approaches have been used to explain human walking mechanisms, from pendular model to fractal approaches. A new perspective can be gained from using the principles developed in the field of Optimization theory and in particularly the branch of Game Theory. In particular we provide a new insight into human walking showing as the trade-off between advancement and equilibrium managed during walking has the same solution of the Ultimatum game, one of the most famous paradigms of game theory, and this solution is the golden ratio. The golden ratio is an irrational number that was found in many biological and natural systems self-organized in a harmonic, asymmetric, and fractal structure. Recently, the golden ratio has also been found as the equilibrium point between two players involved into the Ultimatum Game. It has been suggested that this result can be due to the fact that the golden ratio is perceived as the fairest asymmetric solution by the two players. The golden ratio is also the most common proportion between stance and swing phase of human walking. This approach may explain the importance of harmony in human walking, and provide new perspectives for developing quantitative assessment of human walking, efficient humanoid robotic walkers, and effective neurorobots for rehabilitation.
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Affiliation(s)
- Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
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Darter BJ, Bastian AJ, Wolf EJ, Husson EM, Labrecque BA, Hendershot BD. Locomotor adaptability in persons with unilateral transtibial amputation. PLoS One 2017; 12:e0181120. [PMID: 28704467 PMCID: PMC5507533 DOI: 10.1371/journal.pone.0181120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022] Open
Abstract
Background Locomotor adaptation enables walkers to modify strategies when faced with challenging walking conditions. While a variety of neurological injuries can impair locomotor adaptability, the effect of a lower extremity amputation on adaptability is poorly understood. Objective Determine if locomotor adaptability is impaired in persons with unilateral transtibial amputation (TTA). Methods The locomotor adaptability of 10 persons with a TTA and 8 persons without an amputation was tested while walking on a split-belt treadmill with the parallel belts running at the same (tied) or different (split) speeds. In the split condition, participants walked for 15 minutes with the respective belts moving at 0.5 m/s and 1.5 m/s. Temporal spatial symmetry measures were used to evaluate reactive accommodations to the perturbation, and the adaptive/de-adaptive response. Results Persons with TTA and the reference group of persons without amputation both demonstrated highly symmetric walking at baseline. During the split adaptation and tied post-adaptation walking both groups responded with the expected reactive accommodations. Likewise, adaptive and de-adaptive responses were observed. The magnitude and rate of change in the adaptive and de-adaptive responses were similar for persons with TTA and those without an amputation. Furthermore, adaptability was no different based on belt assignment for the prosthetic limb during split adaptation walking. Conclusions Reactive changes and locomotor adaptation in response to a challenging and novel walking condition were similar in persons with TTA to those without an amputation. Results suggest persons with TTA have the capacity to modify locomotor strategies to meet the demands of most walking conditions despite challenges imposed by an amputation and use of a prosthetic limb.
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Affiliation(s)
- Benjamin J. Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Research, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia, United States of America
- * E-mail:
| | - Amy J. Bastian
- Kennedy Krieger Institute, Baltimore, Maryland, United States of America
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Erik J. Wolf
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), Bethesda, Maryland, United States of America
| | - Elizabeth M. Husson
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- BADER Consortium, University of Delaware, Newark, Delaware, United States of America
| | - Bethany A. Labrecque
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Brad D. Hendershot
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), Bethesda, Maryland, United States of America
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
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Jonkergouw N, Prins MR, Buis AWP, van der Wurff P. The Effect of Alignment Changes on Unilateral Transtibial Amputee's Gait: A Systematic Review. PLoS One 2016; 11:e0167466. [PMID: 27923050 PMCID: PMC5140067 DOI: 10.1371/journal.pone.0167466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Prosthetic alignment, positioning of a prosthetic foot relative to a socket, is an iterative process in which an amputee’s gait is optimized through repetitive optical gait observation and induction of alignment adjustments when deviations are detected in spatiotemporal and kinematic gait parameters. An important limitation of the current prosthetic alignment approach is the subjectivity and the lack of standardized quantifiable baseline values. The purpose of this systematic review is to investigate if an optimal alignment criterion can be derived from published articles. Moreover, we investigated the effect of alignment changes on spatiotemporal, kinematic and kinetic gait parameters. Results A total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies. Discussion The results demonstrate that alignment changes have a predictable influence on the included kinetic parameters. However, the effect of alignment changes on spatio-temporal and kinematic gait parameters are generally unpredictable. These findings suggest that it is imperative to include kinetics in the process of dynamic prosthetic alignment. Partially this can be established by communication with the prosthetic user in terms of perceived socket comfort, but the use of measurement tools should also be considered. While current literature is not conclusive about an optimal alignment, future alignment research should focus on alignment optimisation based on kinetic outcomes.
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Affiliation(s)
- Niels Jonkergouw
- Department of Orthopaedic Technology, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom
- Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands
- * E-mail:
| | - Maarten R. Prins
- Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
- Department of Physical Therapy, HU University of Applied Sciences Utrecht, the Netherlands
| | - Arjan W. P. Buis
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Peter van der Wurff
- Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands
- Department of Physical Therapy, HU University of Applied Sciences Utrecht, the Netherlands
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Rebula JR, Ojeda LV, Adamczyk PG, Kuo AD. The stabilizing properties of foot yaw in human walking. J Biomech 2016; 53:1-8. [PMID: 28161109 DOI: 10.1016/j.jbiomech.2016.11.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/17/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
Humans perform a variety of feedback adjustments to maintain balance during walking. These include lateral footfall placement, and center of pressure adjustment under the stance foot, to stabilize lateral balance. A less appreciated possibility would be to steer for balance like a bicycle, whose front wheel may be turned toward the direction of a lean to capture the center of mass. Humans could potentially combine steering with other strategies to distribute balance adjustments across multiple degrees of freedom. We tested whether human balance can theoretically benefit from steering, and experimentally tested for evidence of steering for balance. We first developed a simple dynamic walking model, which shows that bipedal walking may indeed be stabilized through steering-externally rotating the foot about vertical toward the direction of lateral lean for each footfall-governed by linear feedback control. Moreover, least effort (mean-square control torque) is required if steering is combined with lateral foot placement. If humans use such control, footfall variability should show a statistical coupling between external rotation with lateral placement. We therefore examined the spontaneous fluctuations of hundreds of strides of normal overground walking in healthy adults (N=26). We found significant coupling (P=9·10-8), of 0.54rad of external rotation per meter of lateral foot deviation. Successive footfalls showed a weaker, negative correlation with each other, similar to how a bicycle׳s steering adjustment made for balance must be followed by gradual corrections to resume the original travel direction. Steering may be one of multiple strategies to stabilize balance during walking.
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Affiliation(s)
- John R Rebula
- University of Michigan, Ann Arbor, MI, USA; Intelligent Prosthetic Systems LLC, Madison, WI, USA.
| | | | - Peter G Adamczyk
- University of Michigan, Ann Arbor, MI, USA; Intelligent Prosthetic Systems LLC, Madison, WI, USA; University of Wisconsin - Madison, Madison, WI, USA
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Loyd BJ, Fields TT, Stephenson RO, Stevens-Lapsley J, Christiansen CL. Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation. ACTA ACUST UNITED AC 2016; 53:1035-1044. [PMID: 28355035 DOI: 10.1682/jrrd.2015.03.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 12/15/2015] [Indexed: 11/05/2022]
Abstract
Little evidence exists to support the presence of differences in spatiotemporal gait parameters and ambulation ability between those individuals with traumatic and nontraumatic lower-limb amputation (LLA). We conducted an exploratory study of 81 male Veterans with unilateral amputation to quantify differences in spatiotemporal gait parameters and ambulatory mobility between Veterans with traumatic and nontraumatic LLA. Furthermore, we identified variables that significantly contributed to the explanation of variability in modified 2-min walk test distance. All participants completed the modified 2-min walk test and a spatiotemporal gait analysis using an instrumented walkway during a routine physical therapy visit. Veterans with nontraumatic LLA walked significantly shorter mean distances during a modified 2-min walk test than Veterans with traumatic LLA. Variables identified as significant contributors to modified 2-min walk test variability were amputated limb stance time, amputated limb step length, and percentage of the gait cycle spent in double support. These findings demonstrate that differences in spatiotemporal gait parameters and ambulatory mobility exist between Veterans with traumatic and nontraumatic LLA and identify important spatiotemporal parameters of gait contributing to this decline. These parameters should be considered as targets for intervention and future investigation.
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Affiliation(s)
- Brian J Loyd
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Thomas T Fields
- Department of Physical Medicine and Rehabilitation, Denver Veterans Administration (VA) Medical Center, Denver, CO
| | - Ryan O Stephenson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Department of Physical Medicine and Rehabilitation, Denver Veterans Administration (VA) Medical Center, Denver, CO
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
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Joussain C, Laroche D, Casillas JM, Paysant J, Ader P, Bastable P, Rat Aspert O, Ryall N, Gremeaux V. Transcultural validation of the SIGAM mobility grades in French: The SIGAM-Fr. Ann Phys Rehabil Med 2015; 58:161-6. [PMID: 25958004 DOI: 10.1016/j.rehab.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The main French language scales evaluating functioning after lower-limb amputation have not undergone exhaustive psychometric validation. OBJECTIVE A transcultural validation of the Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire, with 21 closed questions, as an administered questionnaire. METHODS The questionnaire translation, back-translation and original-author validation was followed by a pretest with 5 patients to check comprehension. The psychometric properties of the scale were validated with 49 patients at the definitive prosthesis stage by an investigator via telephone. Criterion validity was evaluated by comparison with the Houghton Scale score and construct validity by correlation between the questionnaire scores and convergent dimensions (performing everyday activities and performing transfers on a numerical rating scale [NRS], 2-min walk test) and divergent dimensions (managing medication and stump skin care on an NRS). Internal consistency was assessed by the Kuder-Richardson Formula 20 (KR-20) coefficient and test-retest reproducibility by the Cohen kappa coefficient. RESULTS The resulting questionnaire was validated by the original author after the back-translation. It showed good psychometric properties when administered by an investigator as a self-reporting questionnaire, excellent criterion validity (r=0.89, P<0.01), excellent reproducibility (kappa coefficient 0.87) and satisfactory construct validity. The KR-20 coefficient was 0.67. CONCLUSION The French version of the SIGAM mobility grades questionnaire (SIGAM-Fr) has satisfactory psychometric properties and can be administered in clinical practice.
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Affiliation(s)
- Charles Joussain
- Pôle rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 21000 Dijon, France.
| | - Davy Laroche
- Inserm CIC-P 803, Inserm U1093 « Cognition, action et plasticité sensorimotrice », plateforme d'investigation technologique, pôle rééducation-réadaptation, CHU de Dijon, 21000 Dijon, France
| | - Jean-Marie Casillas
- Inserm CIC-P 803, Inserm U1093 « Cognition, action et plasticité sensorimotrice », plateforme d'investigation technologique, pôle rééducation-réadaptation, CHU de Dijon, 21000 Dijon, France
| | - Jean Paysant
- Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, 54042 Nancy cedex, France
| | - Philippe Ader
- Pôle rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 21000 Dijon, France
| | - Philip Bastable
- Département d'anglais, faculté de Dijon, 21000 Dijon, France
| | | | - Nicola Ryall
- Prosthetics department, Chapel-Allerton Hospital, Chapeltown road, Leeds, United Kingdom
| | - Vincent Gremeaux
- Inserm CIC-P 803, Inserm U1093 « Cognition, action et plasticité sensorimotrice », plateforme d'investigation technologique, pôle rééducation-réadaptation, CHU de Dijon, 21000 Dijon, France
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