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Bevacqua N, Dell Elce G, Intelangelo L. Effects of combining a high-intensity interval training programme with a standard programme on mobility and function in lower limb amputees. Int J Rehabil Res 2024:00004356-990000000-00096. [PMID: 38881492 DOI: 10.1097/mrr.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
High-energy expenditure during walking is one of the most important limiting factors for lower limb amputees. Although several physical training methods have been proposed to reduce energy expenditure, little is known about the effects of high-intensity interval training in lower limb amputees. This study aimed to test the effects of a 6-week high-intensity interval training protocol in subjects with lower limb amputation on walking distance, physiological cost of walking, and functional mobility. A quasi-experimental pre and post-study included 13 subjects with lower limb amputation. They performed 12 sessions of a high-intensity interval training protocol with a frequency of 2 days/week for 6 weeks. Walking distance, physiological cost of walking, and functional mobility before and after the training protocol were assessed. Walking distance increased from 204.48 to 229.09 m (P = 0.003), physiological cost of walking decreased from 0.66 to 0.31 beats/m (P = 0.001), and functional mobility improved from 30.38 to 33.61 points (P = 0.001). High-intensity interval training improved walking distance, physiological cost of walking, and functional mobility in subjects with lower limb amputation.
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Affiliation(s)
- Nicolás Bevacqua
- Musculoskeletal Research Unit (UIM), University Center of Assistance, Teaching and Research (CUADI), University of Gran Rosario (UGR), Rosario, Argentina
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Panagiotopoulou FV, Michailidis Y, Mandroukas A, Mavropoulos A, Tsimaras V, Nikolaidis PT, Christoulas K, Metaxas T. Match Running Performance Profile and Heart Rate Response in Amputee Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6357. [PMID: 37510589 PMCID: PMC10379046 DOI: 10.3390/ijerph20146357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION The purpose of this study was (a) to create a profile of the running performances of male amputee soccer players in different speed zones, (b) to investigate the relationship between heart rate (HR) and running distance in two soccer matches, and (c) to study the effect of the level of amputation on the running distance covered during a match. MATERIAL AND METHODS The participants were male amputee soccer players (n = 10, Greek, n = 5; Belgian, n = 5) who played two international, friendly matches. Distances were measured using a global positioning system, and HRs were recorded using a Polar Team Pro. RESULTS No differences in the distances covered were observed between participants with different levels of amputation (p > 0.05). Nevertheless, there was a trend that participants with a below-the-knee amputation tended to cover longer distances in total (difference +262.3 m, Cohen's d = 0.40) and in zones 2 (+324.4 m, d = 0.79), 3 (+ 7.1 m, d = 0.65), 4 (+22.7 m, d = 0.43), and 5 (+0.4 m, d = 0.20) and less distance in zone 1 (-207.2 m, d = 0.88). They also tended to perform more accelerations (+3.9, d = 0.89) and decelerations (+4.2, d = 0.87) and had a higher mean HR (+8.4%, d = 2.04) than those with an above-the-knee amputation. Moreover, the mean HR corresponded to 83.3% of the HRmax and did not correlate with distance in any speed zone. CONCLUSIONS It was concluded that the level of amputation might influence running performance and acute physiological response during a soccer match.
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Affiliation(s)
- Foteini-Vasiliki Panagiotopoulou
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Yiannis Michailidis
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Athanasios Mandroukas
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Aris Mavropoulos
- Department of Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Vasilios Tsimaras
- Laboratory of Motor Behaviour and Adapted Physical Activity, Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Pantelis T Nikolaidis
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
| | - Kosmas Christoulas
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Thomas Metaxas
- Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
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Peng L, Wang K, Zeng Y, Wu Y, Si H, Shen B. Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:779019. [PMID: 34926522 PMCID: PMC8677678 DOI: 10.3389/fmed.2021.779019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength, pain, and function outcomes following total knee arthroplasty (TKA). Methods: PubMed/Medline, Embase, Web of Science, CENTRAL, Scopus, PsycINFO, PEDro, CINAHL, CNKI, and Wanfang were systematically searched for randomized controlled trials (RCTs) from their inception to 18 June 2021. Results: Nine RCTs that involving 691 patients were included in the meta-analysis. Our pooled analysis showed that NMES improved quadriceps muscle strength after TKA within 1 months [standardized mean difference (SMD): 0.81; 95% CI: 0.51–1.11], 1–2 months (SMD: 0.55; 95% CI: 0.13–0.97), 3–4 months (SMD: 0.42; 95% CI: 0.18–0.66), and 12–13 months (SMD: 0.46; 95% CI: 0.18–0.74), pain between 1 and 2 months [mean difference (MD): −0.62; 95% CI: −1.04 to −0.19], pain between 3 and 6 months (MD: −0.44; 95% CI: −0.74 to −0.14) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between 3 and 4 months (MD: −0.43; 95% CI: −0.82 to −0.05), timed up and go test (TUG) within 1 month (MD: −2.23; 95% CI: −3.40 to −1.07), 3 minutes walk test between 3 and 6 months (MD: 28.35; 95% CI: 14.55–42.15), and SF-36 MCS between 3 and 6 months after TKA (MD: 4.20, 95% CI: 2.41–5.98). Conclusion: As a supplementary treatment after TKA, postoperative NMES could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function following TKA. However, many outcomes failed to achieve statistically meaningful changes and minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed. Level of Evidence: Therapeutic level I. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021265609.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Kexin Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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von Kaeppler EP, Hetherington A, Donnelley CA, Ali SH, Shirley C, Challa ST, Lutyens E, Haonga BT, Morshed S, Andrysek J, Shearer DW. Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania. Afr J Disabil 2021; 10:839. [PMID: 34692432 PMCID: PMC8517763 DOI: 10.4102/ajod.v10i0.839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background The rise of diabetes and traumatic injury has increased limb loss-related morbidity in low- and middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL ) and function has not been quantified. Objectives Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees. Method A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use. Results Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p < 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p < 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p < 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p = 0.068). Conclusion Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.
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Affiliation(s)
- Ericka P von Kaeppler
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Alexander Hetherington
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Claire A Donnelley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Syed H Ali
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Corin Shirley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Sravya T Challa
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | | | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Saam Morshed
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Jan Andrysek
- LegWorks, Inc., Buffalo, United States of America.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - David W Shearer
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
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Exercise improves neurotrophins in multiple sclerosis independent of disability status. Mult Scler Relat Disord 2020; 43:102143. [DOI: 10.1016/j.msard.2020.102143] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
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Schack J, Mirtaheri P, Steen H, Gjøvaag T. Assessing mobility for persons with lower limb amputation: the Figure-of-Eight Walk Test with the inclusion of two novel conditions. Disabil Rehabil 2019; 43:1323-1332. [PMID: 31526078 DOI: 10.1080/09638288.2019.1662495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the internal consistency, convergent and known-groups construct validity of the Figure-of-Eight Walk Test with two novel conditions in persons with lower limb amputation, and to examine differences in walking performance between the three conditions within a group of persons with transtibial amputation and transfemoral amputation/knee disarticulation. MATERIALS AND METHODS Fifty adults with unilateral amputation participated, 28 of whom had undergone a transtibial amputation and 22 a transfemoral amputation/knee disarticulation. Three Figure-of-Eight Walk Test conditions were investigated: 1) walking at a self-selected walking speed, 2) walking while carrying a tray with two cups of water, and 3) walking on uneven terrain. Internal consistency was evaluated using Cronbach's alpha. Convergent construct validity was examined by analysing the relationship between the Figure-of-Eight Walk Test parameters and performance-based parameters (Amputee Mobility Predictor, Ten-Meter Walk Test, Six-Minute Walk Test) and self-report measures (Prosthetic Limb Users Survey of Mobility, Activities-specific Balance Confidence Scale) using Spearman's rank-order correlations. Known-groups construct validity was assessed by comparing the Figure-of-Eight Walk Test parameters based on anatomical level of amputation. Friedman's test and post hoc analysis were used to examine differences between the walking conditions within each group. RESULTS Cronbach's alpha coefficients of the Figure-of-Eight Walk Test parameters for all three conditions ranged from 0.89 to 0.99. The Figure-of-Eight Walk Test time and step parameters demonstrated moderate to good correlation (ρ = -0.50 to -0.77) for performance-based mobility measures. The correlations were stronger during Condition 3 in comparison with the original Figure-of-Eight Walk Test. The correlation was fair to good (ρ = -0.41 to -0.57) for the self-report mobility measures. Comparison between groups showed a difference between transtibial and transfemoral amputation/knee disarticulation participants when it comes to the Figure-of-Eight Walk Test time and smoothness parameters in Condition 2 (p < 0.05). Comparison between walking conditions within each group showed significant differences in the Figure-of-Eight Walk Test parameters in the two novel conditions in comparison with the original Figure-of-Eight Walk Test. The Figure-of-Eight Walk Test and the novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity. Future studies should further develop and standardise the smoothness scale to better quantify walking performance and assess the responsiveness and reliability (inter-rater and intra-rater) of the Figure-of-Eight Walk Test (time and steps) and the novel conditions, while studies on known-groups validity should include persons with a wider mobility range.IMPLICATIONS FOR REHABILITATIONFigure-of-Eight Walk Test with the two novel conditions, which include carrying a load and walking on uneven terrain, may help to provide meaningful information about walking ability in daily life.The two novel conditions pose different challenges to persons with lower limb amputation when compared to the original Figure-of-Eight Walk Test and underscore the relevance to assess mobility under challenging walking conditions.The Figure-of-Eight Walk Test and the two novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity.
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Affiliation(s)
- Jette Schack
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Peyman Mirtaheri
- Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Harald Steen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Biomechanics Lab, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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van Schaik L, Geertzen JHB, Dijkstra PU, Dekker R. Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis. PLoS One 2019; 14:e0213256. [PMID: 30893346 PMCID: PMC6426184 DOI: 10.1371/journal.pone.0213256] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 02/19/2019] [Indexed: 01/09/2023] Open
Abstract
Objective To systematically review the literature on the metabolic costs of activities of daily living (ADL) in persons with a lower limb amputation (LLA). Data sources A literature search was undertaken in the Pubmed, Embase, CINAHL, CENTRAL, and PsycINFO databases using keywords and synonyms for LLA, metabolic costs, and ADL. The last search was performed on November 29th, 2017. Study selection Studies were included if they met the following 2 criteria: participants were adults with a (unilateral or bilateral) LLA and metabolic costs were measured while participants performed a physical activity or ADL. Data extraction and synthesis Data of 1,912 participants from 61 studies were included in the systematic review and meta-analysis. The studies used different terms to describe metabolic costs. Participants were recruited in different settings, relatively healthy, with few comorbidities. Limited data were available on metabolic costs of other activities than walking with a prosthesis. A linear mixed model analysis was performed based on the means reported, with study as unit of analysis and test results of different groups and measurement conditions as repeated measures within the unit of analysis. Predictors entered in the analysis were e.g. level and reason of amputation, age, weight, and height. During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Additionally, oxygen consumption was determined by the interaction terms walking speed x amputation level and walking speed squared. Heart rate was determined by the interaction term walking speed squared. Conclusion During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Data on metabolic costs of other activities were limited. The poor quality of the studies and the relatively healthy participants limited generalizability of the results of the meta-analysis.
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Affiliation(s)
- Loeke van Schaik
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
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Ladlow P, Nightingale TE, McGuigan MP, Bennett AN, Phillip RD, Bilzon JLJ. Predicting ambulatory energy expenditure in lower limb amputees using multi-sensor methods. PLoS One 2019; 14:e0209249. [PMID: 30703115 PMCID: PMC6354995 DOI: 10.1371/journal.pone.0209249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess the validity of a derived algorithm, combining tri-axial accelerometry and heart rate (HR) data, compared to a research-grade multi-sensor physical activity device, for the estimation of ambulatory physical activity energy expenditure (PAEE) in individuals with traumatic lower-limb amputation. Methods Twenty-eight participants [unilateral (n = 9), bilateral (n = 10) with lower-limb amputations, and non-injured controls (n = 9)] completed eight activities; rest, ambulating at 5 progressive treadmill velocities (0.48, 0.67, 0.89, 1.12, 1.34m.s-1) and 2 gradients (3 and 5%) at 0.89m.s-1. During each task, expired gases were collected for the determination of V˙O2 and subsequent calculation of PAEE. An Actigraph GT3X+ accelerometer was worn on the hip of the shortest residual limb and, a HR monitor and an Actiheart (AHR) device were worn on the chest. Multiple linear regressions were employed to derive population-specific PAEE estimated algorithms using Actigraph GT3X+ outputs and HR signals (GT3X+HR). Mean bias±95% Limits of Agreement (LoA) and error statistics were calculated between criterion PAEE (indirect calorimetry) and PAEE predicted using GT3X+HR and AHR. Results Both measurement approaches used to predict PAEE were significantly related (P<0.01) with criterion PAEE. GT3X+HR revealed the strongest association, smallest LoA and least error. Predicted PAEE (GT3X+HR; unilateral; r = 0.92, bilateral; r = 0.93, and control; r = 0.91, and AHR; unilateral; r = 0.86, bilateral; r = 0.81, and control; r = 0.67). Mean±SD percent error across all activities were 18±14%, 15±12% and 15±14% for the GT3X+HR and 45±20%, 39±23% and 34±28% in the AHR model, for unilateral, bilateral and control groups, respectively. Conclusions Statistically derived algorithms (GT3X+HR) provide a more valid estimate of PAEE in individuals with traumatic lower-limb amputation, compared to a proprietary group calibration algorithm (AHR). Outputs from AHR displayed considerable random error when tested in a laboratory setting in individuals with lower-limb amputation.
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Affiliation(s)
- Peter Ladlow
- Department for Health, University of Bath, Bath, United Kingdom
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, United Kingdom
| | | | | | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rhodri D. Phillip
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, United Kingdom
| | - James L. J. Bilzon
- Department for Health, University of Bath, Bath, United Kingdom
- * E-mail:
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Andrysek J, Wright FV, Rotter K, Garcia D, Valdebenito R, Mitchell CA, Rozbaczylo C, Cubillos R. Long-term clinical evaluation of the automatic stance-phase lock-controlled prosthetic knee joint in young adults with unilateral above-knee amputation. Disabil Rehabil Assist Technol 2016; 12:378-384. [PMID: 27376843 DOI: 10.3109/17483107.2016.1173730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to clinically evaluate the automatic stance-phase lock (ASPL) knee mechanism against participants' existing weight-activated braking (WAB) prosthetic knee joint. METHOD This prospective crossover study involved 10 young adults with an above-knee amputation. Primary measurements consisted of tests of walking speeds and capacity. Heart rate was measured during the six-minute walk test and the Physiological Cost Index (PCI) which was calculated from heart rate estimated energy expenditure. Activity was measured with a pedometer. User function and quality of life were assessed using the Lower Limb Function Questionnaire (LLFQ) and Prosthetic Evaluation Questionnaire (PEQ). Long-term follow-up over 12 months were completed. RESULTS Walking speeds were the same for WAB and APSL knees. Energy expenditure (PCI) was lower for the ASPL knees (p = 0.007). Step counts were the same for both knees, and questionnaires indicated ASPL knee preference attributed primarily to knee stability and improved walking, while limitations included terminal impact noise. Nine of 10 participants chose to keep using the ASPL knee as part of the long-term follow-up. CONCLUSIONS Potential benefits of the ASPL knee were identified in this study by functional measures, questionnaires and user feedback, but not changes in activity or the PEQ.
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Affiliation(s)
- Jan Andrysek
- a Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute , Toronto , Canada.,b Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Canada
| | - F Virginia Wright
- a Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute , Toronto , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , Canada
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Hordacre B, Bradnam LV, Barr C, Patritti BL, Crotty M. Intracortical inhibition is modulated by phase of prosthetic rehabilitation in transtibial amputees. Front Hum Neurosci 2015; 9:276. [PMID: 26042015 PMCID: PMC4436885 DOI: 10.3389/fnhum.2015.00276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/27/2015] [Indexed: 11/13/2022] Open
Abstract
Reorganization of primary motor cortex (M1) is well-described in long-term lower limb amputees. In contrast cortical reorganization during the rehabilitation period after amputation is poorly understood. Thirteen transtibial amputees and 13 gender matched control participants of similar age were recruited. Transcranial magnetic stimulation was used to assess corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were conducted at admission, prosthetic casting, first walk and discharge. Gait variability at discharge was assessed as a functional measure. Compared to controls, amputees had reduced short-latency intracortical inhibition (SICI) for the ipsilateral M1 at admission (p = 0.01). Analysis across rehabilitation revealed SICI was reduced for the contralateral M1 at first walk compared to discharge (p = 0.003). For the ipsilateral M1 both short and long-latency intracortical inhibition were reduced at admission (p < 0.05) and prosthetic casting (p < 0.02). Analysis of the neurophysiology and gait function revealed several interesting relationships. For the contralateral M1, reduced inhibition at admission (p = 0.04) and first walk (p = 0.05) was associated with better gait function. For the ipsilateral M1, reduced inhibition at discharge (p = 0.05) was associated with poor gait function. This study characterized intracortical excitability in rehabilitating amputees. A dichotomous relationship between reduced intracortical inhibition for each M1 and gait function was observed at different times. Intracortical inhibition may be an appropriate cortical biomarker of gait function in lower limb amputees during rehabilitation, but requires further investigation. Understanding M1 intracortical excitability of amputees undertaking prosthetic rehabilitation provides insight into brain reorganization in the sub-acute post-amputation period and may guide future studies seeking to improve rehabilitation outcomes.
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Affiliation(s)
- Brenton Hordacre
- Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University Adelaide, SA, Australia
| | - Lynley V Bradnam
- Applied Brain Research Laboratory, Centre for Neuroscience, School of Medicine, Flinders University Adelaide, SA, Australia ; Discipline of Physiotherapy, School of Health Sciences, Flinders University Adelaide, SA, Australia ; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Christopher Barr
- Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University Adelaide, SA, Australia
| | - Benjamin L Patritti
- Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University Adelaide, SA, Australia
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