Upper body accelerations during level walking in transtibial amputees.

BACKGROUND:: The observation of upper body movement is gaining interest in the gait analysis community. Recent studies involved the use of body-worn motion sensors, allowing translation of laboratory measurements to real-life settings in the context of patient monitoring and fall prevention. OBJECTIVES:: It was shown that amputee persons demonstrate altered acceleration patterns due to the presence of prosthetic components, while no information is available on how accelerations propagate upwards to the head during level walking. This descriptive study aims to fill this gap. STUDY DESIGN:: Original research report. METHODS:: Twenty definitive prosthesis users with transtibial amputation and 20 age-matched able-bodied individuals participated in the study. Three magneto-inertial measurement units were placed at head, sternum and pelvis level to assess acceleration root mean square. Three repetitions of the 10-m walking test were performed at a self-selected speed. RESULTS:: Acceleration root mean square was significantly larger at pelvis and head level in individuals with amputation than in able-bodied participants, mainly in the transverse plane ( p < 0.05). Differences were also observed in how accelerations propagate upwards, highlighting that a different motor strategy is adopted in amputee persons gait to compensate for increased instability. CONCLUSION:: The obtained parameters allow an objective mobility assessment of amputee persons that can integrate with the traditional clinical approach. CLINICAL RELEVANCE: Transtibial amputees exhibit asymmetries due to the sound limb's support prevalence during gait: this is evidenced by amplified accelerations on the transverse plane and by related differences in upper body movement control. Assessing these accelerations and their attenuations upwards may be helpful to understand amputee's motor strategies and to improve prosthetic training.

Comparison between SACH foot and a new multiaxial prosthetic foot during walking in hypomobile transtibial amputees: physiological responses and functional assessment.

BACKGROUND: The most prescribed prosthetic foot for hypomobile transtibial amputees (TTAs) is the solid ankle cushion heel (SACH). Recently, the new 1M10 Adjust (Ottobock, Duderstadt, Germany) has been designed for hypomobile TTAs. No studies are available about the physiological responses to walking with 1M10 Adjust or about the related energy cost of walking (ECW). The aim of this study was to assess physiological responses to walking with 1M10 Adjust and with SACH in low-mobility TTAs and their ECW, and to compare 1M10 Adjust and SACH for physiological responses, ECW, relative perceived effort and satisfaction (SATPRO) using the prosthesis. DESIGN: Observational study. SETTING: The study was conducted in the outpatient rehabilitation unit of a rehabilitation center. POPULATION: Twenty hypomobile unilateral TTAs were enrolled. Amputees who ranged K-levels 1 or 2 were defined. METHODS: TTAs performed two over ground walking tests in two separate days, with an interval time in between of 30 days. TTAs performed the first walking test wearing their habitual SACH foot; the second walking test fitting the 1M10 Adjust, after 30 days of its use. During walking tests, TTAs walked back and forth for 6 minutes at self-selected walking speed (SSWS) and physiological data were collected. At the end of each walking test, the relative perceived effort was assessed by Borg scale. Finally, SATPRO questionnaire was administered. RESULTS: Twenty TTAs (17 males) were enrolled (mean age, body mass and height were 66.6±6.7 years, 78.5±13.2 kg, and 168.5±7.5 cm, respectively): 19 had a K-level 2 and one had a K-level 1. Physiological responses using SACH or 1M10 Adjust foot did not show statistical differences. ECW, SSWS and relative perceived effort significantly improved using the 1M10 Adjust. Satisfaction with 1M10 Adjust was significantly greater than with SACH. CONCLUSIONS: TTAs showed a significant improvement in ECW, relative perceived effort and SATPRO with 1M10 Adjust than with SACH. This suggests that 1M10 Adjust foot could be a good choice for hypomobile TTAs. CLINICAL REHABILITATION IMPACT: The better prosthetic performance provided by 1M10 Adjust foot during gait could improve mobility in TTAs with low mobility contributing to prevent comorbidity deriving from sedentary lifestyle. With its long-term benefits, 1M10 Adjust could contribute to a better quality of life.

Wheelchair Propulsion Biomechanics in Junior Basketball Players: A Method for the Evaluation of the Efficacy of a Specific Training Program.

As participation in wheelchair sports increases, the need of quantitative assessment of biomechanical performance indicators and of sports- and population-specific training protocols has become central. The present study focuses on junior wheelchair basketball and aims at (i) proposing a method to identify biomechanical performance indicators of wheelchair propulsion using an instrumented in-field test and (ii) developing a training program specific for the considered population and assessing its efficacy using the proposed method. Twelve athletes (10 M, 2 F, age = 17.1 ± 2.7 years, years of practice = 4.5 ± 1.8) equipped with wheelchair- and wrist-mounted inertial sensors performed a 20-metre sprint test. Biomechanical parameters related to propulsion timing, progression force, and coordination were estimated from the measured accelerations and used in a regression model where the time to complete the test was set as dependent variable. Force- and coordination-related parameters accounted for 80% of the dependent variable variance. Based on these results, a training program was designed and administered for three months to six of the athletes (the others acting as control group). The biomechanical indicators proved to be effective in providing additional information about the wheelchair propulsion technique with respect to the final test outcome and demonstrated the efficacy of the developed program.

The Conventional Non-Articulated SACH or a Multiaxial Prosthetic Foot for Hypomobile Transtibial Amputees? A Clinical Comparison on Mobility, Balance, and Quality of Life.

The effects of a non-articulated SACH and a multiaxial foot-ankle mechanism on the performance of low-activity users are of great interest for practitioners in amputee rehabilitation. The aim of this study is to compare these two prosthetic feet and assess possible improvements introduced by the increased degrees of freedom provided by the multiaxial foot. For this purpose, a group of 20 hypomobile transtibial amputees (TTAs) had their usual SACH replaced with a multiaxial foot. Participants' functional mobility, involving ambulatory skills in overground level walking, ramps, and stairs, was evaluated by performing Six-Minute Walking Test (6 MWT), Locomotor Capability Index-5 (LCI-5), Hill Assessment Index (HAI), and Stair Assessment Index (SAI). Balance performances were assessed using Berg Balance Scale (BBS) and analysing upper body accelerations during gait. Moreover, the Prosthesis Evaluation Questionnaire (PEQ) was performed to indicate the prosthesis-related quality of life. Results showed that participants walked faster using the multiaxial foot (p < 0.05) maintaining the same upright gait stability. Significant improvements with the multiaxial foot were also observed in BBS, LCI-5, and SAI times and 4 of 9 subscales of the PEQ. Our findings demonstrate that a multiaxial foot represents a considerable alternative solution with respect to the conventional SACH in the prosthetic prescription for hypomobile TTAs.

Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations.

Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001), harmony (p < 0.001), and symmetry (p < 0.001) of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

Assessment of the effects of carbon fiber and bionic foot during overground and treadmill walking in transtibial amputees.

OBJECTIVE: To determine the energy cost of walking (ECW) of a bionic foot (Proprio-Foot®) during ambulation on floor and on treadmill (at different slopes) compared to walking with a dynamic carbon fiber foot (DCF). We evaluated transtibial amputees (TTAs) perceived mobility with the prosthesis and their walking ability on stairs and ramps. METHOD: TTAs were enrolled. The ECW tests were conducted on a regular floor surface and on treadmill with -5%, 0% and 12% slopes. In all conditions, TTAs were asked to walk at their own self-selected speed. Metabolic and cardiac data were collected using a portable gas analyzer. Tests were performed at six data collection points: first with a standard suction system (SSS) and the DCF; second, with the DCF after 7 weeks of using a hypobaric suspension system (HSS) with the DCF; third, after 1 h of Proprio-Foot® use together with the HSS; three more testing sessions were carried out at 30-day intervals, i.e., after 30, 60 and 90 days of Proprio-Foot® use together with the HSS. TTAs perceived mobility using the prosthesis and walking ability on stairs and ramps were assessed. RESULTS: Ten TTAs completed the measurements. ECW with the Proprio-Foot® obtained in the final floor-walking test was significantly lower than ECW with the DCF (p=0.002). No significant improvements were observed for perceived mobility or walking ability. CONCLUSIONS: Results suggest that use of the Proprio-Foot® can lower the ECW for TTAs in spite of its added weight compared to DCF.

A comparison between the suction suspension system and the hypobaric Iceross Seal-In® X5 in transtibial amputees.

BACKGROUND: The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system. OBJECTIVES: The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees. STUDY DESIGN: Single-group repeated measures. METHODS: Ten amputees were enrolled. The pistoning test, used to compare vertical movement of the stump within the socket, and the energy cost of walking test were carried out when the amputees were wearing the suction suspension system and after 2, 5, and 7 weeks of Seal-In® X5 use. The Prosthesis Evaluation Questionnaire and the Houghton Scale Questionnaire of perceived mobility and quality of life with the prosthesis, and the Timed Up&Go Test and the Locomotor Capability Index for functional mobility were also administered at the beginning and end of the study. RESULTS: The hypobaric Iceross Seal-In® X5 led to significant pistoning reduction and improvement on the Houghton Scale Questionnaire and 3 of 9 domains of the Prosthesis Evaluation Questionnaire. No statistical changes were observed in functional mobility or the energy cost of walking tests. CONCLUSION: Replacing the suction suspension system with the hypobaric Iceross Seal-In® X5 improves quality of life in transtibial amputees.

Energy cost of walking in transfemoral amputees: Comparison between Marlo Anatomical Socket and Ischial Containment Socket.

OBJECTIVE: To compare energy cost of walking (ECW) and prosthesis-related perceived mobility with the Marlo Anatomical Socket (MAS(®)) and the Ischial Containment (IC) Socket. METHOD: Transfemoral (TF) amputees were enrolled in the study. ECW tests were conducted inside, in a hallway with a regular floor surface. Subjects had to walk back and forth on a 61m linear course at their own self-selected speed. Metabolic and heart rate data were collected during the walking test using a portable gas analyzer. All measurements were made at steady state (SS). The tests were performed first using the IC socket and then after 30 days of MAS(®) use; the last test was carried out after 60 days of MAS(®) use. The amputees were also administered the Prosthetic Evaluation Questionnaire Mobility Section (PEQ MS) at the first and the last test to assess perceived potential for mobility using the prosthesis. RESULTS: Seven long-term prosthesis users were analyzed. Their mean age was 33.9±9.3 years; all were employed, active, and used IC sockets. At the third walking test, the ECW with the MAS(®) was significantly lower than that with the IC socket (p=.016). PEQ MS data also improved significantly at the last evaluation (p<.018). CONCLUSION: Results suggest that using the MAS(®), lowering the ECW and improving PEQ MS, could be a valid prosthesis design for active TF amputees compared to their usual IC socket.