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Hu M, He Y, Hisano G, Hobara H, Kobayashi T. Coordination of Lower Limb During Gait in Individuals With Unilateral Transfemoral Amputation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3835-3843. [PMID: 37721878 DOI: 10.1109/tnsre.2023.3316749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Understanding the lower-limb coordination of individuals with unilateral transfemoral amputation (uTFA) while walking is essential to understand their gait mechanisms. Continuous relative phase (CRP) analysis provides insights into gait coordination patterns of the neuromusculoskeletal system based on movement kinematics. Fourteen individuals with uTFA and their age-matched non-disabled individuals participated in this study. Kinematic data of the lower limbs of the participants were collected during walking. The joint angles, segment angles, and CRP values of the thigh-shank and shank-foot couplings were investigated. The curves among the lower limbs of the participants were compared using a statistical parametric mapping test. Compensatory strategies were found in the lower limbs from coordination patterns. In thigh-shank coupling, although distinct coordination traits in stance and swing phases among the lower limbs were found, the lower limbs in both groups were discovered to remain in a similar coordination pattern during gait. For individuals with uTFA, in shank-foot coupling, intact limbs demonstrated a short period of foot-leading pattern which was significantly different from that of the other limbs during mid-stance to compensate for the weaker force generation by prosthetic limbs. The findings offer normative coordination patterns on the walking of individuals with uTFA, which could benefit prosthetic gait rehabilitation and development.
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Hu M, Kobayashi T, Hisano G, Murata H, Ichimura D, Hobara H. Sprinting performance of individuals with unilateral transfemoral amputation: compensation strategies for lower limb coordination. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221198. [PMID: 36908994 PMCID: PMC9993038 DOI: 10.1098/rsos.221198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Understanding the sprinting patterns of individuals with unilateral transfemoral amputation (uTFA) is important for designing improved running-specific prostheses and for prosthetic gait rehabilitation. Continuous relative phase (CRP) analysis acquires clues from movement kinematics and obtains insights into the sprinting coordination of individuals with uTFA. Seven individuals with uTFA sprinted on a 40 m runway. The spatio-temporal parameters, joint and segment angles of the lower limbs were obtained, and CRP analysis was performed on thigh-shank and shank-foot couplings. Subsequently, the asymmetry ratios of the parameters were calculated. Statistical analyses were performed between the lower limbs. Significant differences in the stance time, stance phase percentage, ankle joint angles and CRP of the shank-foot coupling (p < 0.05) were observed between the lower limbs. The primary contributor to these differences could be the structural differences between the lower limbs. Despite the presence of different coordination features in the stance and swing phases between the lower limbs, no significant difference in the coordination patterns of the thigh-shank coupling was observed. This may be a compensation strategy for achieving coordination patterns with improved symmetry between the lower limbs. The results of this study provide novel insights into the sprinting movement patterns of individuals with uTFA.
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Affiliation(s)
- Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Genki Hisano
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
- Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo 102-0083, Japan
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0014, Japan
| | - Hiroto Murata
- Department of Mechanical Engineering, Tokyo University of Science, Chiba 278-8510, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0014, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo 125-8585, Japan
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Lathouwers E, Díaz MA, Maricot A, Tassignon B, Cherelle C, Cherelle P, Meeusen R, De Pauw K. Therapeutic benefits of lower limb prostheses: a systematic review. J Neuroeng Rehabil 2023; 20:4. [PMID: 36639655 PMCID: PMC9840272 DOI: 10.1186/s12984-023-01128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life. OBJECTIVE To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation. METHODS We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189. RESULTS We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias. CONCLUSION Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.
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Affiliation(s)
- Elke Lathouwers
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Alejandra Díaz
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Alexandre Maricot
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Bruno Tassignon
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | | | - Romain Meeusen
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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Finco MG, Moudy SC, Patterson RM. Normalized kinematic walking symmetry data for individuals who use lower-limb prostheses: considerations for clinical practice and future research. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2023; 35:e1-e17. [PMID: 37008386 PMCID: PMC10062529 DOI: 10.1097/jpo.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT
Introduction
Individuals who use unilateral transtibial or transfemoral prostheses have negative secondary health effects associated with decreased kinematic (e.g., spatiotemporal and joint angle) walking symmetry between prosthetic and intact limbs. Research studies have quantified kinematic walking symmetry, but studies can be difficult to compare owing to the inclusion of small sample sizes and differences in participant demographics, biomechanical parameters, and mathematical analysis of symmetry. This review aims to normalize kinematic walking symmetry research data across studies by level of limb loss and prosthetic factors to inform considerations in clinical practice and future research.
Methods
A search was performed on March 18, 2020, in PubMed, Scopus, and Google Scholar to encompass kinematic walking symmetry literature from the year 2000. First, the most common participant demographics, kinematic parameters, and mathematical analysis of symmetry were identified across studies. Then, the most common mathematical analysis of symmetry was used to recalculate symmetry data across studies for the five most common kinematic parameters.
Results
Forty-four studies were included in this review. The most common participant demographics were younger adults with traumatic etiology who used componentry intended for higher activity levels. The most common kinematic parameters were step length, stance time, and sagittal plane ankle, knee, and hip range of motion. The most common mathematical analysis was a particular symmetry index equation.
Conclusions
Normalization of data showed that symmetry tended to decrease as level of limb loss became more proximal and to increase with prosthetic componentry intended for higher activity levels. However, most studies included 10 or fewer individuals who were active younger adults with traumatic etiologies.
Clinical Relevance
Data summarized in this review could be used as reference values for rehabilitation and payer justification. Specifically, these data can help guide expectations for magnitudes of walking symmetry throughout rehabilitation or to justify advanced prosthetic componentry for active younger adults under 65 years of age with traumatic etiologies to payers.
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Affiliation(s)
- M G Finco
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Sarah C Moudy
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
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Mahon CE, Hendershot BD. Biomechanical accommodation to walking with an ankle-foot prosthesis: An exploratory analysis of novice users with transtibial limb loss within the first year of ambulation. Prosthet Orthot Int 2022; 46:452-458. [PMID: 35333820 DOI: 10.1097/pxr.0000000000000124] [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: 01/18/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The way in which a person with limb loss interacts with a prosthesis changes over time; however, there remains a lack of guidance for defining accommodation to walking with a prosthesis, limiting consistency and generalizability of research. OBJECTIVE To evaluate accommodations to walking with dynamic elastic response prosthetic ankle-foot devices among novice users with unilateral transtibial limb loss during the first year of ambulation. STUDY DESIGN This is a retrospective cohort study. METHODS Prosthetic and intact ankle-foot mechanical power profiles and mechanical work during step-to-step transitions were calculated using the Unified Deformable model for 22 male individuals with limb loss at five time points within the first year of independent ambulation (0, 2, 4, 6, and 12 months). Subjects walked at a self-selected walking velocity and controlled walking velocity (CWV). Subjective measures included the Prosthetic Evaluation Questionnaire and the 36-Item Short-Form Health Survey. RESULTS Self-selected walking velocity ranged from 1.24 ± 0.06 m/s at 0 month to 1.38 ± 0.04 m/s at 12 months, whereas CWV was 1.20 ± 0.02 m/s. At both velocities, positive work/peak power during prosthetic push-off trended upward until the 4-month time point. In addition, negative peak power during intact foot-strike seemed to qualitatively become less negative until 4 months. Positive work during intact push-off trended downward until 4 months at CWV, whereas positive peak power during intact push-off qualitatively became more positive at self-selected walking velocity. CONCLUSIONS These trends may partially indicate (biomechanical) accommodation to walking by appearance of a "plateau" at 4 months after initial ambulation with a prosthesis.
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Affiliation(s)
- Caitlin E Mahon
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brad D Hendershot
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Kim JJ, Cho H, Park Y, Jang J, Kim JW, Ryu JS. Biomechanical influences of gait patterns on knee joint: Kinematic & EMG analysis. PLoS One 2020; 15:e0233593. [PMID: 32470052 PMCID: PMC7259630 DOI: 10.1371/journal.pone.0233593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background As lumbar spinal stenosis commonly occurs between the L2 and L5 segments, hip abductors are easily affected. However, studies regarding the gait pattern in these patients from the coronal plane have not yet been conducted. Purpose To determine the effects of lumbar spinal stenosis on the gait pattern (stride width and femorotibial angle) and hip abductor surface electromyography in varied stride widths compared with healthy individuals. Study design Prospective case-control study. Methods Seventeen patients and 20 healthy individuals were enrolled. Each participant completed three gait assessments in their normal gait, adducted gait and abducted gait. The femorotibial angle and surface electromyography signals were measured. Pain scores was used to quantify the degree of discomfort in the gluteal area and medial side of the knee. Results When the hip abductors’ surface electromyography signals were normalized by quadriceps femoris, patients group showed significantly higher activation ratios throughout all gait patterns. Generally, surface electromyography signals and ratios were significantly higher during abducted gait compared with a normal gait. Femorotibial angle became significantly closer to the varus in healthy individuals during abducted gait. When femorotibial angle during normal gait was compared between the two groups, patients group exhibited slightly wider stride width and FTA significantly closer to the varus. Pain scores were significantly higher in the patient group and during abducted gait. Conclusion Wider stride widths indicated increased relative activation of the hip abductors, closer proximity between femorotibial angle and varus, and increased pain scores for discomfort. The same tendency was observed in patients group when compared with healthy individuals. Widening of stride width in patients group despite abductor weakness suggests that additional muscle recruitment may be needed to maintain balance. Furthermore, such a distinctive gait pattern exerts increased loading on the medial knee, relating to the escalated risk of degenerative knee osteoarthritis.
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Affiliation(s)
- Jin Ju Kim
- Department of Medicine, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Han Cho
- Department of Medicine, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Yulhyun Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Joonyoung Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jung Woo Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seongnam-si, Republic of Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
- * E-mail:
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Beausoleil S, Miramand L, Turcot K. Evolution of gait parameters in individuals with a lower-limb amputation during a six-minute walk test. Gait Posture 2019; 72:40-45. [PMID: 31136941 DOI: 10.1016/j.gaitpost.2019.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A recent amputation leads to decreased functional capacities in the lower limb amputees (LLA), especially during walking. Assessments of LLA's gait in clinical settings are used to provide feedback on their evolution without quantifying gait parameters distinctly, unlike new technologies, such as inertial sensors (IMUs), which have demonstrated their effectiveness in different environments and populations. RESEARCH QUESTION How do the spatial-temporal gait parameters and kinematics of the LLA evolve quantitatively over a six-minute walk test (6MWT) and is the use of inertial sensors relevant in clinical practice to quantify those parameters? METHODS Fifteen LLA from a study cohort performed a 6MWT post-rehabilitation, wearing inertial sensors on both feet to provide gait parameters (i.e., minimum toe clearance (minTC), speed, cadence, stance time and foot flat ratio (FFr)) over this test. A non-parametric ANOVA was conducted comparing the evolution of each parameter over the 6MWT (12 intervals of 30 s). Significance level was set at P ≤ 0.05. Post-hoc Wilcoxon signed-rank tests were performed if a main effect was detected. RESULTS MinTC and stance phase variability along the 6MWT were significantly different over time. Cadence variability and speed variation were significantly different between both feet (amputated and non-amputated leg). SIGNIFICANCE The increased variability in gait parameters along the 6MWT suggests a greater risk of future mobility problems following a return in community. The data provided by the IMUs reflect the potential of the clinical rehabilitation programme and could, therefore, help clinicians to refine their interventions.
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Affiliation(s)
- Sarah Beausoleil
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Ludovic Miramand
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Katia Turcot
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada.
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