Effects of long-distance walking on socket-limb interface pressure, tactile sensitivity and subjective perceptions of trans-tibial amputees

Purpose: Many trans-tibial amputees could not tolerate long-distance walking. Lack of walking could explain for the increased cardiovascular diseases mortality rate. This study investigated the effects of long-distance walking (LDW) on socket-limb interface pressure, tactile sensitivity of the residual limb, and subjective feedbacks, which potentially identified the difficulties in LDW. Method: Five male unilateral trans-tibial amputees walked on a level treadmill for a total of one hour at comfortable speed. Tactile sensitivity of the residual limb and socket-limb interface pressure during over-ground walking were measured before and after the treadmill walking. Modified Prosthesis Evaluation Questionnaires were also administered. Results: After the treadmill walking, the socket-limb interface pressure and the tactile sensitivity at the popliteal depression area were significantly reduced. This corresponds well with the questionnaire results showing that the level of discomfort and pain of the residual limb did not increase. The questionnaire revealed that there were significant increases in fatigue level at the sound-side plantar flexors, which could lead to impaired dynamic stability. Conclusions: Fatigue of sound-side plantar-flexor was the main difficulty faced by the five subjects when walking long-distances. This finding might imply the importance of refining prosthetic components and rehabilitation protocols in reducing the muscle fatigue. Implications for Rehabilitation After long-distance walking (LDW) of the trans-tibal amputee subjects, there were significant increases in fatigue level at the plantar flexors. These might explain the reduced walking stability as perceived by the subjects. LDW did not produce any problems in residual-limb comfort and pain feeling. These were in line with the significant reductions of socket-limb interface pressure and the tactile sensitivity at the popliteal depression after LDW. Refinements of prosthetic components and rehabilitation protocols should be attempted to reduce the fatigue of the plantar flexors and facilitate LDW.

[1]  A. Mak,et al.  Regional differences in pain threshold and tolerance of the transtibial residual limb: including the effects of age and interface material. , 2005, Archives of physical medicine and rehabilitation.

[2]  A W Buis,et al.  Calibration problems encountered while monitoring stump/socket interface pressures with force sensing resistors: Techniques adopted to minimise inaccuracies , 1997, Prosthetics and orthotics international.

[3]  J. Collins,et al.  Enhancing tactile sensation in older adults with electrical noise stimulation , 2002, Neuroreport.

[4]  K. Matsuoka,et al.  Effect of prolonged free-walking fatigue on gait and physiological rhythm. , 2004, Journal of biomechanics.

[5]  A A Polliack,et al.  Scientific validation of two commercial pressure sensor systems for prosthetic socket fit , 2000, Prosthetics and orthotics international.

[6]  Jacques Duysens,et al.  Plantar pressure changes after long-distance walking. , 2010, Medicine and science in sports and exercise.

[7]  Koepke Gh,et al.  Effect of liner materials on interface pressures in below-knee prostheses. , 1970 .

[8]  Xiaohong Jia,et al.  Effects of alignment on interface pressure for transtibial amputee during walking , 2007, i-CREATe '07.

[9]  G. Street,et al.  A comparison of trans-tibial amputee suction and vacuum socket conditions , 2001, Prosthetics and orthotics international.

[10]  E. Isakov,et al.  Dynamic loading on the human musculoskeletal system -- effect of fatigue. , 1998, Clinical biomechanics.

[11]  P C O'Brien,et al.  A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold , 1993, Neurology.

[12]  Andrea Russo,et al.  Walking one hour or more per day prevented mortality among older persons: results from ilSIRENTE study. , 2008, Preventive medicine.

[13]  Ming Zhang,et al.  Quantifying the Regional Load-Bearing Ability of Trans-Tibial Stumps , 2006, Prosthetics and orthotics international.

[14]  G H Koepke,et al.  Effect of liner materials on interface pressures in below-knee prostheses. , 1970, Archives of physical medicine and rehabilitation.

[15]  S. Lord,et al.  Postural stability and associated physiological factors in a population of aged persons. , 1991, Journal of gerontology.

[16]  G D Reiber,et al.  Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. , 1998, Archives of physical medicine and rehabilitation.

[17]  J. Czerniecki,et al.  Recreational activities of lower-limb amputees with prostheses. , 2001, Journal of rehabilitation research and development.

[18]  M. Cornwall,et al.  Plantar tactile sensory thresholds in healthy men and women , 2006 .

[19]  D L Bader,et al.  Effect of externally applied skin surface forces on tissue vasculature. , 1986, Archives of physical medicine and rehabilitation.

[20]  Aft Mak,et al.  State-of-the-art research in lower-limb prosthetic biomechanics-socket interface , 2001 .

[21]  Ming Zhang,et al.  Long-distance walking effects on trans-tibial amputees compensatory gait patterns and implications on prosthetic designs and training. , 2012, Gait & posture.

[22]  I. Narang,et al.  Functional capabilities of lower limb amputees , 1984, Prosthetics and orthotics international.

[23]  D G Ferris,et al.  Measurement of subjective phenomena in primary care research: the Visual Analogue Scale. , 1993, Family practice research journal.

[24]  A F Mak,et al.  Biomechanical assessment of below-knee residual limb tissue. , 1994, Journal of rehabilitation research and development.

[25]  Steven J Stanhope,et al.  Strength asymmetry and osteoarthritis risk factors in unilateral trans-tibial, amputee gait. , 2010, Gait & posture.

[26]  Ming Zhang,et al.  Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion. , 2010, Annual review of biomedical engineering.

[27]  Israel Dudkiewicz,et al.  Satisfaction rates amongst elderly amputees provided with a static prosthetic foot , 2011, Disability and rehabilitation.

[28]  W. Robert Harris,et al.  CANADIAN EXPERIENCE WITH THE PATELLAR TENDON BEARING BELOW-KNEE PROSTHESIS , 1962 .

[29]  B. Nigg,et al.  Quantifying a relationship between tactile and vibration sensitivity of the human foot with plantar pressure distributions during gait. , 1999, Clinical biomechanics.

[30]  B. Modan,et al.  Increased cardiovascular disease mortality rates in traumatic lower limb amputees. , 1998, The American journal of cardiology.

[31]  J. Naschitz,et al.  Why traumatic leg amputees are at increased risk for cardiovascular diseases. , 2008, QJM : monthly journal of the Association of Physicians.

[32]  Tracy L Beil,et al.  Interface pressures during ambulation using suction and vacuum-assisted prosthetic sockets. , 2002, Journal of rehabilitation research and development.

[33]  Angus McFadyen,et al.  Dynamic interface pressure distributions of two transtibial prosthetic socket concepts. , 2009, Journal of rehabilitation research and development.

[34]  V. C. Roberts,et al.  Frictional action at lower limb/prosthetic socket interface. , 1996, Medical engineering & physics.

[35]  E M Burgess,et al.  Interface shear stresses during ambulation with a below-knee prosthetic limb. , 1992, Journal of rehabilitation research and development.

[36]  A F Mak,et al.  State-of-the-art research in lower-limb prosthetic biomechanics-socket interface: a review. , 2001, Journal of rehabilitation research and development.

[37]  C. Ring,et al.  Effects of isometric exercise on pain are mediated by blood pressure , 2008, Biological Psychology.

[38]  Xiaohong Jia,et al.  Finite element modeling of the contact interface between trans-tibial residual limb and prosthetic socket. , 2004, Medical engineering & physics.