James A Sturk1, Edward D Lemaire1,2, Emily H Sinitski1, Nancy L Dudek2, Markus Besemann3, Jacqueline S Hebert4,5, Natalie Baddour6. 1. a Centre for Rehab Research and Development , Ottawa Hospital Research Institute , Ottawa , Canada. 2. b Faculty of Medicine , University of Ottawa , Ottawa , Canada. 3. c Department of Rehabilitation , Canadian Forces Health Services , Ottawa , Canada. 4. d Alberta Health Services , Glenrose Rehabilitation Hospital , Edmonton , Canada. 5. e Division of Physical Medicine and Rehabilitation , University of Alberta , Edmonton , Canada. 6. f Department of Mechanical Engineering , University of Ottawa , Ottawa , Canada.
Abstract
PURPOSE: Describe and quantify how people with transfemoral amputations (TFA) maintain stable gait over a variety of surfaces; including, downhill and uphill, top and bottom-cross-slopes, medial-lateral translations, rolling hills and simulated rocky surfaces. METHODS: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration). RESULTS AND CONCLUSIONS: TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA. Implications for Rehabilitation Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces. Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance. Gait parameter variability typically increased from the level condition in both groups. Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed. Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit.
PURPOSE: Describe and quantify how people with transfemoral amputations (TFA) maintain stable gait over a variety of surfaces; including, downhill and uphill, top and bottom-cross-slopes, medial-lateral translations, rolling hills and simulated rocky surfaces. METHODS: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration). RESULTS AND CONCLUSIONS:TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA. Implications for Rehabilitation Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces. Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance. Gait parameter variability typically increased from the level condition in both groups. Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed. Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit.
Authors: Matthew M Wernke; Evandro M Ficanha; Zac Thomas; Murray E Maitland; Katheryn J Allyn; Alex Albury; James Colvin Journal: J Rehabil Assist Technol Eng Date: 2022-09-07