A characterisation of established unilateral transfemoral amputee gait using 3D kinematics, kinetics and oxygen consumption measures.

BACKGROUND Persons with unilateral transfemoral (UTF) amputation are known to walk with less efficiency than able-bodied individuals, therefore understanding the gait deviations that drive this inefficiency was considered to be important. RESEARCH QUESTIONS What are the differences in gait outcomes between persons with UTF amputation and able-bodied persons? What is the prevalence of specific gait deviations within this group? METHODS Using a cross-sectional study design, the level over ground gait of established prosthetics service users with UTF amputation using mechanical knee joints (n=60) were compared with able-bodied persons (n=10). Gait profile score, walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, centre of mass deviation and metabolic energy expenditure were measured. All data were captured during walking on level ground at a self-selected speed. Prevalence of gait deviations for each UTF participant were assessed by inspection, using a predefined list of lower limb kinematic, upper body kinematic, ground reaction force and lower limb kinetic gait deviations. RESULTS Statistically significant between-groups differences across all outcome measures were found, with all p-values <0.005, and effect sizes ranging from 'large' to 'huge'. The most prevalent gait deviations included: lack of prosthetic knee flexion in early stance (98%); lack of hip extension on the prosthetic side in late stance (82%): increased trunk side flexion range of motion across the gait cycle (92%); reduced anterior propulsion force on the prosthetic side in late stance (100%) and reduced prosthetic hip adduction moment in early stance (96%). SIGNIFICANCE The results of this study indicate that the magnitude of the differences between UTF amputees and able-bodied persons, across a comprehensive range of gait measures, are such that significant research into all aspects of prosthetic rehabilitation to reduce these differences is clearly justified.

[1]  R. Baker,et al.  Temporal Spatial and Metabolic Measures of Walking in Highly Functional Individuals With Lower Limb Amputations. , 2017, Archives of physical medicine and rehabilitation.

[2]  M. Nash,et al.  The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate. , 2002, Archives of physical medicine and rehabilitation.

[3]  Suh-Jen Lin,et al.  Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation. , 2014, Gait & posture.

[4]  E. Russell Esposito,et al.  The influence of traumatic transfemoral amputation on metabolic cost across walking speeds , 2018, Prosthetics and orthotics international.

[5]  Hartmut Witte,et al.  ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. , 2002, Journal of biomechanics.

[6]  Kenton R Kaufman,et al.  Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. , 2008, Archives of physical medicine and rehabilitation.

[7]  G. Verni,et al.  Reference values for gait temporal and loading symmetry of lower-limb amputees can help in refocusing rehabilitation targets , 2018, Journal of NeuroEngineering and Rehabilitation.

[8]  Steven A Gard,et al.  The biomechanical response of persons with transfemoral amputation to variations in prosthetic knee alignment during level walking. , 2016, Journal of rehabilitation research and development.

[9]  A. McIntosh,et al.  Use of gait summary measures with lower limb amputees. , 2012, Gait & posture.

[10]  A. Rutkowska-Kucharska,et al.  Relationship between Asymmetry of Gait and Muscle Torque in Patients after Unilateral Transfemoral Amputation , 2018, Applied bionics and biomechanics.

[11]  T. Theologis,et al.  Prediction of the hip joint centre in adults, children, and patients with cerebral palsy based on magnetic resonance imaging. , 2007, Journal of biomechanics.

[12]  R Baker,et al.  Pelvic angles: a mathematically rigorous definition which is consistent with a conventional clinical understanding of the terms. , 2001, Gait & posture.

[13]  Stephen T Wegener,et al.  Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. , 2005, Archives of physical medicine and rehabilitation.

[14]  Angus K McFadyen,et al.  Physical activity and quality of life: A study of a lower-limb amputee population , 2008, Prosthetics and orthotics international.

[15]  Adam Rozumalski,et al.  The gait profile score and movement analysis profile. , 2009, Gait & posture.

[16]  J. Eng,et al.  Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. , 2003, Gait & posture.

[17]  Steven J Stanhope,et al.  A unified deformable (UD) segment model for quantifying total power of anatomical and prosthetic below-knee structures during stance in gait. , 2012, Journal of biomechanics.

[18]  P. Leva.  Adjustments to Zatsiorsky-Seluyanov's segment inertia parameters. , 1996 .

[19]  Malte Bellmann,et al.  Comparative biomechanical analysis of current microprocessor-controlled prosthetic knee joints. , 2010, Archives of physical medicine and rehabilitation.

[20]  W. V. D. van den Heuvel,et al.  A systematic literature review of quality of life in lower limb amputees , 2011, Disability and rehabilitation.

[21]  L. V. D. van der Woude,et al.  Physical capacity and walking ability after lower limb amputation: a systematic review , 2006, Clinical rehabilitation.

[22]  M. Schwartz,et al.  A nondimensional normalization scheme for oxygen utilization data. , 2006, Gait & posture.

[23]  T. Schmalz,et al.  Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. , 2002, Gait & posture.

[24]  Daniel P. Ferris,et al.  Metabolic and mechanical energy costs of reducing vertical center of mass movement during gait. , 2009, Archives of physical medicine and rehabilitation.

[25]  J. Donelan,et al.  Mechanical and metabolic requirements for active lateral stabilization in human walking. , 2004, Journal of biomechanics.

[26]  Susan J Hillman,et al.  Repeatability of a new observational gait score for unilateral lower limb amputees. , 2010, Gait & posture.

[27]  Skinner Hb,et al.  Gait analysis in amputees. , 1985 .

[28]  Bryan Buchholz,et al.  ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand. , 2005, Journal of biomechanics.

[29]  H. J. de Jongh,et al.  Prosthetic gait of unilateral transfemoral amputees: a kinematic study. , 1995, Archives of physical medicine and rehabilitation.

[30]  Kenton R Kaufman,et al.  Gait asymmetry of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. , 2012, Clinical biomechanics.

[31]  Stefania Fatone,et al.  Northwestern University Flexible Subischial Vacuum Socket for persons with transfemoral amputation-Part 1: Description of technique , 2017, Prosthetics and orthotics international.

[32]  Eric C Honert,et al.  Ankle and foot power in gait analysis: Implications for science, technology and clinical assessment. , 2018, Journal of biomechanics.

[33]  Pascale Fodé,et al.  Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. , 2008, Archives of physical medicine and rehabilitation.

[34]  H. Skinner,et al.  Gait analysis in amputees. , 1985, American journal of physical medicine.

[35]  David A. Winter,et al.  Biomechanics and Motor Control of Human Movement , 1990 .

[36]  T. Cahalan,et al.  Isometric and isokinetic hip abductor strength in persons with above-knee amputations. , 1988, Archives of physical medicine and rehabilitation.

[37]  M Twiste,et al.  Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking. , 2017, Gait & posture.

[38]  S. Sawilowsky.  New Effect Size Rules of Thumb , 2009 .

[39]  J. Czerniecki,et al.  Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees. , 2006, Journal of rehabilitation research and development.