Compensatory mechanisms of transtibial amputees during circular turning

Ventura, Jessica D.; Segal, Ava D.; Klute, Glenn K.; Neptune, Richard R.

doi:10.1016/j.gaitpost.2011.05.014

Cited by 42 publications

(32 citation statements)

References 30 publications

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“…These results suggest that the hip joints in ILEA with RSPs have a shock-absorbing function rather than a spring-like function. In fact, some previous studies demonstrated this unique compensatory strategy involving the hip joint during walking in transtibial amputees (Grumillier et al, 2008; Ventura et al, 2011). Further, Galli et al (2008) demonstrated that a similar distinct impact of hip extension moment at early stance phase during walking was observed in subjects with Down syndrome, but not in a control group.…”

Section: Discussionmentioning

confidence: 92%

Amputee locomotion: Spring-like leg behavior and stiffness regulation using running-specific prostheses

Hobara

Baum

Kwon

et al. 2013

Journal of Biomechanics

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Carbon fiber running-specific prostheses (RSPs) have allowed individuals with lower extremity amputation (ILEA) to participate in running. It has been established that as running speed increases, leg stiffness (Kleg) remains constant while vertical stiffness (Kvert) increases in able-bodied runners. The Kvert further depends on a combination of the torsional stiffnesses of the joints (joint stiffness; Kjoint) and the touchdown joint angles. Thus, an increased understanding of spring-like leg function and stiffness regulation in ILEA runners using RSPs is expected to aid in prosthetic design and rehabilitation strategies. The aim of this study was to investigate stiffness regulation to various overground running speeds in ILEA wearing RSPs. Eight ILEA performed overground running at a range of running speeds. Kleg, Kvert and Kjoint were calculated from kinetic and kinematic data in both intact and prosthetic limbs. Kleg and Kvert in both limbs remained constant when running speed increased, while intact limbs in ILEA running with RSPs have a higher Kleg and Kvert than residual limbs. There were no significant differences in Kankle, Kknee and touchdown knee angle between the legs at all running speeds. Hip joints in both legs did not demonstrate spring-like function; however, distinct impact peaks were observed only in the intact leg hip extension moment at early stance phase, indicating that differences in Kvert between limbs in ILEA are due to attenuating shock with the hip joint. Therefore, these results suggest that ILEA using RSPs have a different stiffness regulation between the intact and prosthetic limbs during running.

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Section: Discussionmentioning

confidence: 92%

Amputee locomotion: Spring-like leg behavior and stiffness regulation using running-specific prostheses

Hobara

Baum

Kwon

et al. 2013

Journal of Biomechanics

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“…41 Study interventions were designed to strategically address specific body function impairments common in people with lower-limb amputation that contribute to activity limitations: decreased hip extension range of motion, 42 gluteal weakness, 14 balance impairment, 29 and functional prosthetic turning deficits. 43,44 The sequence of specific interventions was guided by the spinal stability model proposed by Panjabi, 45 popularized by Lee,46 and expanded to include movement by Hoffman. 47 Briefly summarized, when passive joint structures either (a) insufficiently stabilize or (b) excessively restrict normal movement, active muscular structures deviate from the normal pelvic stability and hip mobility functions-observed as weakness and dysfunctional movement.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Four-Session Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and Prosthetic Walking Ability of People with Lower-Limb Amputation: A Pilot Study

et al. 2016

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Purpose: No consensus exists regarding best practice for prosthetic rehabilitation programs after unilateral lower-limb amputation. A program integrating manual therapy with exercise for people using lower-limb prostheses has not been systematically investigated. The objectives of this pilot study were to determine whether a four-session physical therapy program of manual therapy, exercise, and functional training would (1) be feasible for people with lower-limb amputation and (2) produce medium to large effect size changes in balance and walking ability and self-reported prosthetic function. Methods: Five subjects were recruited for this pretest-posttest design pilot study. Outcome measures included self-report scales (Houghton Scale, Prosthetics Evaluation Questionnaire, fear of falling, and Activities-Specific Balance Confidence) and clinical performance assessments: Berg Balance Scale, 2-minute walk test, and timed up and go test. One week after the four-session manual therapy, exercise, and functional training program concluded, measures were reassessed. Effect size d and Wilcoxon P values were calculated. Results: Five subjects (average age, 54.0 years), with unilateral amputations of mixed etiology and level, completed the study without adverse event. Berg Balance Scale (d = 1.7, p < 0.05), timed up and go (d = 1.05, p > 0.05), and 2-minute walk test (d = 1.18, p < 0.05) had large effect size changes. Conclusions: A four-session program of manual therapy, exercise, and functional training proved feasible and increased balance and walking ability in people with lower-limb amputation. Controlled research to determine the effects of manual therapy and exercise in this population appears warranted. (J Prosthet Orthot. 2016;28:95-100.) KEY INDEXING TERMS:Berg balance scale, exercise, functional mobility, gait, limb loss, lower-limb, manual therapies, prosthesis, 2-minute walk test T he prevalence of people with amputations is expected to more than double to 3.6 million by 2050, with 40% having had major lower-limb loss. 1 After lower-limb amputation, a multitude of individual and clinical factors can impact community mobility and participation outcomes among users of prostheses. 2 In a review of 48 studies, balance impairment was identified as the most consistent clinical finding associated with decreased prosthetic function. 3 Gait dysfunction persists, with approximately half not achieving a satisfactory level of prosthetic use even after multiple years. 4,5 As hospital lengths of stay have decreased for individuals after amputations, 6 more prosthetic gait training occurs in outpatient settings. A recent systematic review found that few detailed outpatient rehabilitation programs for users of lower-limb prostheses have been researched. 7 Although no best practice consensus approach was determined, rehabilitation programs ranging from specific exercises, balance training, resisted gait training, and indoor and outdoor functional walking have been shown to improve gait performance as assessed by gait speed. 7 ...

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“…However, studies of four representative daily activities show that turning steps may account for an average of 25 percent of steps, ranging from 8 to 50 percent of all steps depending on the activity [12], which people with amputation accomplish using different control strategies than nondisabled people. While a nondisabled person relies on hip movement in the coronal plane and moments generated at the ankle, a person with amputation using a passive prosthesis relies on hip extension in the sagittal plane [13][14][15][16]. During a turn, modulation of ankle impedance in the sagittal and frontal planes plays a major role in controlling lateral and propulsive ground reaction forces in order to accelerate the body's center of mass along the gait path; thus, during a turning step, lateral and propulsive impulses are larger than during a straight step [17].…”

Section: Introductionmentioning

confidence: 99%

“…During a turn, modulation of ankle impedance in the sagittal and frontal planes plays a major role in controlling lateral and propulsive ground reaction forces in order to accelerate the body's center of mass along the gait path; thus, during a turning step, lateral and propulsive impulses are larger than during a straight step [17]. This difference will result in different gait strategies between people with amputation and nondisabled people to compensate for the lack of propulsion from a passive prosthesis in order to increase maneuverability [13]. This suggests that an ankle-foot prosthesis capable of generating moments in two DOFs, i.e., dorsiflexion-plantar flexion (DP) and inversion-eversion (IE) directions, with impedance modulation similar to the human ankle will augment maneuverability and mobility that leads to a more agile gait.…”

Section: Introductionmentioning

confidence: 99%

Ankle mechanics during sidestep cutting implicates need for 2-degrees of freedom powered ankle-foot prostheses

2015

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Abstract-The ankle joint of currently available powered prostheses is capable of controlling one degree of freedom (DOF), focusing on improved mobility in the sagittal plane. To increase agility, the requirements of turning in prosthesis design need to be considered. Ankle kinematics and kinetics were studied during sidestep cutting and straight walking. There were no significant differences between the ankle sagittal plane mechanics when comparing sidestep cutting and straight walking; however, significant differences were observed in ankle frontal plane mechanics. During straight walking, the inversion-eversion (IE) angles were smaller than with sidestep cutting. The ankle that initiated the sidestep cutting showed progressively increasing inversion from 2 to 13 degrees while the following contralateral step showed progressively decreasing inversion from 8 to 4 degrees during normal walking speed. The changes in IE kinematics were the most significant during sidestep cutting compared with straight walking. The IE moments of the step that initiated the sidestep cutting were always in eversion, acting as a braking moment opposing the inverting motion. This suggests that an ankle-foot prosthesis with active DOFs in the sagittal and frontal planes will increase the agility of gait for patients with limb loss.

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Compensatory mechanisms of transtibial amputees during circular turning

Cited by 42 publications

References 30 publications

Amputee locomotion: Spring-like leg behavior and stiffness regulation using running-specific prostheses

Amputee locomotion: Spring-like leg behavior and stiffness regulation using running-specific prostheses

Impact of a Four-Session Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and Prosthetic Walking Ability of People with Lower-Limb Amputation: A Pilot Study

Ankle mechanics during sidestep cutting implicates need for 2-degrees of freedom powered ankle-foot prostheses

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