Search

Background: The company Ethnocare has developed the Overlay, a new pneumatic solution for managing volumetric variations (VVs) of the residual limb (RL) in transtibial amputees (TTAs), which improves socket fitting. However, the impact of the Overlay during functional tasks and on the comfort and pain felt in the RL is unknown., Methods: 8 TTAs participated in two evaluations, separated by two weeks. We measured compensatory strategies (CS) using spatio-temporal parameters and three-dimensional lower limb kinematics and kinetics during gait and sit-to-stand (STS) tasks. During each visit, the participant carried out our protocol while wearing the Overlay and prosthetic folds (PFs), the most common solution to VV. Between each task, comfort and pain felt were assessed using visual analog scales., Results: While walking, the cadence with the Overlay was 105 steps/min, while it was 101 steps/min with PFs ( p = 0.021). During 35% and 55% of the STS cycle, less hip flexion was observed while wearing the Overlay compared to PFs ( p = 0.004). We found asymmetry coefficients of 13.9% with the Overlay and 17% with PFs during the STS ( p = 0.016) task. Pain ( p = 0.031), comfort ( p = 0.017), and satisfaction ( p = 0.041) were better with the Overlay during the second visit., Conclusion: The Overlay's impact is similar to PFs' but provides less pain and better comfort.

Gait parameters are altered and asymmetrical in individuals with transtibial amputation. The purpose of this study was to evaluate and compare the effect of four different prosthetic feet on lower-limb biomechanics during gait. A 34-year-old man with transtibial amputation performed four gait analysis sessions with four foot-ankle prostheses (Variflex, Meridium, Echelon, and Kinterra). Kinematic and kinetic parameters and gait symmetry were analyzed in different prosthetic conditions. The type of prosthesis had little effect on the participant's spatiotemporal parameters. Throughout the stance phase, increased hip angle, reduced knee flexion and ankle dorsiflexion were observed in the amputated leg. For kinetic parameters, reduced propulsive force (SI = 0.42-0.65), reduced knee extension moment (mainly during Echelon and Kinterra conditions, SI = 0.17 and 0.32, respectively), and increased knee abduction moment (mainly during the Variflex and Meridium, SI = 5.74 and 8.93, respectively) were measured in the amputated leg. Lower support moments were observed in the amputated leg as compared to the unaffected leg, regardless of the type of prosthesis (SI = 0.61-0.80). The prostheses tested induced different lower-limb mechanical adaptations. In order to achieve the clinical goal of better gait symmetry between lower limbs, an objective gait analysis could help clinicians to prescribe prosthetic feet based on quantitative measurement indicators to optimize gait rehabilitation.

Background: Many individuals with a transtibial amputation (TTA) exhibit balance deficits after limb loss. However, limited evidence exists on balance deficits of individuals with a TTA using hip, knee, and ankle kinematics and center of mass outcomes., Objectives: To identify balance control deficits in individuals with a TTA and determine to what extent they are accentuated without visual inputs., Study Design: Cross-sectional., Methods: Ten individuals with TTA and 10 healthy controls undertook a biomechanical assessment during a 30-s quiet standing task with eyes open (EO) and eyes closed (EC). The mean trunk, hip, knee, and ankle angles and center of pressure (COP) and center of mass excursions were calculated., Results: More ankle dorsiflexion was observed for amputated limbs compared with intact lower limbs (mean difference: 5.8-degree, P = 0.031). Less anteroposterior (mean difference: 26.5 mm, P < 0.001) and mediolateral (ML) (mean difference: 4.2 mm, P = 0.042) COP excursions were found for amputated limbs compared with intact lower limbs and for control limbs compared with intact limbs (mean difference: 18.8 mm, P = 0.019). Greater ML COP excursion was found during EC than during EO condition (mean difference: 1.1 mm, P = 0.037)., Conclusions: Individuals with a TTA presented a greater reliance on the intact lower limb, as highlighted by the greater ankle plantarflexion and anteroposterior and ML COP excursions for intact limbs compared with amputated limbs during quiet standing tasks. During EC condition, both groups exhibited greater ML COP excursions compared with EO condition, suggesting less postural stability. These differences may place them at greater risk of falling., (Copyright © 2021 International Society for Prosthetics and Orthotics.)

Inertial measurement units and normative values enable clinicians to quantify clinical walking tests and set rehabilitation goals. Objectives of this study were (1) to compare time- and distance-based walking tests in individuals with lower limb amputation (iLLA) and normative values following rehabilitation discharge (T1) and 6 weeks after discharge (T2) and (2) to investigate spatiotemporal and foot kinematic parameters over a 6-minute walk test using inertial measurement units. Twelve iLLA participated in this study. Distance, cadence, stance ratio, loading rate ratio, push-up ratio, path length, and minimum toe clearance were analyzed during 6-minute walk test. Nonparametric repeated-measures analysis of variance tests, Bonferroni corrections, were performed. Time of distance-based walking tests diminished at T2 (P < .02). Compared with normative values, walking performance in iLLA was reduced. Cadence at T2 increased significantly (P = .026). Stance ratio increased in both legs at T2 (P < .05). Push-up ratio tended to decrease at T2 in the amputated leg (P = .0003). Variability of path length and minimum toe clearance at T2 were less than at T1 in the nonamputated leg (P < .05). Spatiotemporal improvement at T2 could be due to prosthesis adaptation in iLLA. The lower performance of the functional walk test compared with normative values could be due to amputation and pain-related fatigue.

Background: Most previous studies reported biomechanical deficits in individuals with a trans-tibial amputation (TTA) during gait using zero-dimensional analyses. However, these analyses do not allow to precisely determine during which part of the gait cycle these deficits occur. There is a need to use more appropriate methods to map the differences, such as one-dimensional statistical parametric mapping., Research Question: What are the most relevant phases of the gait cycle during which the biomechanical deficits in TTA occur?, Methods: Eight TTA and 15 healthy counterparts (CON) underwent one biomechanical gait analysis. Pelvis, hip, knee and ankle kinematics, total support moment (TSM) and gastrocnemius lateralis, vastus lateralis and tibialis anterior muscle activity were compared between the amputated (AmLL), the intact (InLL) and the control (CnLL) lower limbs using one-dimensional statistical parametric mapping., Results: More ankle dorsiflexion and knee flexion were observed for the AmLL compared to the InLL and CnLL (ankle only) from the end of the stance phase to the beginning of the swing phase. Less knee flexion was also found for the AmLL during early stance phase. More pelvis posterior tilt and rotation toward the contralateral limb was observed during most of the gait cycle for the AmLL compared to the InLL. TSM was smaller for the AmLL compared to the CnLL during early stance phase., Significance: Using a one-dimensional statistical parametric mapping approach for TTA gait analysis, this study provides novel insights on their biomechanical gait deficits compared to CON. Greater reliance on the InLL was observed in TTA as suggested by the asymmetric kinematic and kinetic profiles., (Copyright © 2021 Elsevier B.V. All rights reserved.)

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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA)., Methods: We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C., Results: The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation., Conclusion: This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Abstract: Objective: To compare the well-recognized solid ankle cushion heel (SACH) foot with the prosthetic foot developed by the International Committee of the Red Cross (CR Equipements SACH) during gait. Design: Double-blind study was conducted to compare the influence on the biomechanics of gait of the CR Equipements SACH foot and the SACH foot. Setting: University hospital research center. Participants: Participants with unilateral transtibial amputation (N=15) were included. Interventions: Three-dimensional motion analysis system and 2 forceplates were used to capture body motion and ground reaction forces during gait at a self-selected speed and at 1.2m/s. Main Outcome Measures: Nonparametric Wilcoxon matched-pairs tests were used to compare the 2 prosthetic feet with respect to their spatiotemporal (gait velocity, stride length, and percentage of stance phase), kinematic (range and peak angles of the pelvis, hip, knee, and ankle), and kinetic (peak moment and power of the hip, knee, and ankle) parameters. Results: Compared with the SACH foot, the CR Equipements SACH foot demonstrated a significantly greater stance phase symmetry ratio (SACH: 94% vs CR Equipements SACH: 97%), a more extensive ankle range of motion in the sagittal plane (SACH: 7° vs CR Equipements SACH: 12°), a greater maximal dorsiflexion angle during the terminal stance phase (SACH: 10° vs CR Equipements SACH: 13°), and a higher ankle power (SACH: .31W/kg vs CR Equipements SACH: .40W/kg). No significant difference was found for the examined knee, hip, and pelvis parameters. Conclusions: The CR Equipements SACH foot provides more symmetry and improves ankle kinematics and kinetics in the sagittal plane compared with the SACH foot. This study suggests that individuals using the CR Equipements SACH foot improve their gait biomechanics compared when using the SACH foot. [Copyright &y& Elsevier]

Individuals with a lower limb amputation use compensatory strategies during essential tasks such as sit-to-stand and stair ascent leading to secondary physical conditions. The ensuing biomechanical parameters outlining the motion strategies they put in place need to be identified and described. We searched three databases (Embase, IEEE Xplore and PubMed) for articles on the spatiotemporal, the kinematics and the kinetics that compared the amputated, the intact lower limbs, or the trunk of individuals with a unilateral transtibial or transfemoral amputation with the limbs of a control group. We found twenty articles. During sit-to-stand, individuals with a lower limb amputation increased the trunk inclination angle toward the intact lower limb, explaining higher ground reaction forces and peak knee sagittal power generation. During stair ascent, individuals with a lower limb amputation increased the stance phase duration on the intact lower limb. Moreover, individuals with a lower limb amputation increased both lower limbs hip extension moment and power, and the amputated lower limb knee extension moment. In both tasks, the individuals with a transfemoral amputation presented larger differences than those with transtibial compared to the control group. Both lower limbs intact joint moment and power were increased to compensate for the prosthesis passive joint and to ensure stability. Stair gait studies mainly focused on the lower limbs' biomechanical changes in the sagittal plane, while sit-to-stand studies focused on asymmetries without comparing the lower limbs independently. Better methodological descriptions are essential to enhance the external validity of previous results. • Stair gait and sit-to-stand are crucial for individuals with lower limb amputation. • Trunk and lower limbs need to be investigated during both tasks. • This review identified the most relevant parameters underlying movement strategies. • Moment and power show that residual joints compensate for the prosthetic joint. • Trunk and lower limb need to be more investigated during both tasks. [ABSTRACT FROM AUTHOR]