Leg Muscle Strength in Below-Knee Amputees

Bäcklund, L; Lemperg, Rudolf; L, Ottosson

doi:10.3109/17453676808989445

Cited by 7 publications

(25 citation statements)

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“…The purpose of the present study was to determine the effect of muscle strength loss following unilateral transtibial limb loss on the metabolic cost of walking. Several previous studies have used similar methods to simulate various practical and hypothetical aspects of amputee locomotion [ 8 , 9 , 15 , 16 ], but the present study is the first to our knowledge to model the muscle strength losses typically seen in the general limb loss population, as well as the maintenance of strength often seen in high-functioning individuals within this population [ 39 , 46 ]. In support of the hypothesis, the main result was that metabolic cost of optimal control simulations of walking with a passive transtibial prosthesis did not increase post-limb loss if pre-limb loss muscle strength was maintained.…”

Section: Discussionmentioning

confidence: 99%

“…Strength training has been shown to reduce the metabolic cost of walking in individuals with transtibial limb loss [ 48 ]. The tested condition of no strength loss is a plausible and achievable goal of rehabilitation: physically active individuals with transtibial limb loss can often have no substantial strength asymmetries at the hip or knee, and similar levels of strength compared to non-amputees [ 39 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

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Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss

Esposito

Miller

2018

PLoS ONE

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Recent studies on relatively young and fit individuals with limb loss suggest that maintaining muscle strength after limb loss may mitigate the high metabolic cost of walking typically seen in the larger general limb loss population. However, these data are cross-sectional and the muscle strength prior to limb loss is unknown, and it is therefore difficult to draw causal inferences on changes in strength and gait energetics. Here we used musculoskeletal modeling and optimal control simulations to perform a longitudinal study (25 virtual “subjects”) of the metabolic cost of walking pre- and post-limb loss (unilateral transtibial). Simulations of walking were first performed pre-limb loss on a model with two intact biological legs, then post-limb loss on a model with a unilateral transtibial prosthesis, with a cost function that minimized the weighted sum of gait deviations plus metabolic cost. Metabolic costs were compared pre- vs. post-limb loss, with systematic modifications to the muscle strength and prosthesis type (passive, powered) in the post-limb loss model. The metabolic cost prior to limb loss was 3.44±0.13 J/m/kg. After limb loss, with a passive prosthesis the metabolic cost did not increase above the pre-limb loss cost if pre-limb loss muscle strength was maintained (mean -0.6%, p = 0.17, d = 0.17). With 10% strength loss the metabolic cost with the passive prosthesis increased (mean +5.9%, p < 0.001, d = 1.61). With a powered prosthesis, the metabolic cost was at or below the pre-limb loss cost for all subjects with strength losses of 10% and 20%, but increased for all subjects with strength loss of 30% (mean +5.9%, p < 0.001, d = 1.59). The results suggest that maintaining muscle strength may prevent an increase in the metabolic cost of walking following unilateral transtibial limb loss, and that a gait with minimal deviations can be achieved when muscle strength is sufficiently high, even when using a passive prosthesis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss

Esposito

Miller

2018

PLoS ONE

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“…20,21 The able-bodied persons in the present study exhibited a concentric flexion/extension ratio of 0.56 and an eccentric ratio of 0.54-0.59 indicating this group is at the lower end of the reported AB range. Ba¨cklund et al 6 reported isometric hip extension strength was greater than isometric hip flexion strength in sedentary TT amputees, and proposed that this was due to the fact that hip flexors are less exercised than hip extensors. Hip extensor muscles function as antigravity muscles and thus are naturally exercised more than hip flexor muscles.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Strength differences between limbs, measured as flexion and extension torques at the knee 1,2,4,5 or hip isometric strength, 6 have previously been reported of up to 47% in sedentary transtibial (TT) amputees, the residual limb being weaker than the intact limb. These studies are in agreement that the quadriceps tend to be more atrophied and weaker than the hamstrings.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, authors have suggested that a deficiency in hip muscle strength may contribute to poor walking ability 12, 13 and an inability to run or walk quickly would be expected to be a result of inadequate training of the hip flexors. 6 Thus it appears that for lower limb amputees, the important muscle groups for good walking or running, and thus ability to be sports-active, are the muscles surrounding the hip joint. To date, no published studies have either investigated the amount of hip flexion or extension strength asymmetry or, in a training study, tried to increase hip strength in lower limb amputees in order to investigate whether this improves their walking or running or ability to be sports-active.…”

Section: Introductionmentioning

confidence: 99%

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Lower Limb Strength in Sports-Active Transtibial Amputees

Nolan¹

2009

Prosthetics &Amp; Orthotics International

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The aim of this study was to compare hip strength in sports-active transtibial (TT) amputees, sedentary TT amputees and sports-active non-amputees. Three 'active' (exercising recreationally at least three times per week) TT amputees, four 'inactive' or sedentary TT amputees and nine 'active' able-bodied persons (AB) underwent concentric and eccentric hip flexion and extension strength testing on both limbs on an isokinetic dynamometer at 60 and 120 degrees /s. Little strength asymmetry was noted between the limbs of the active TT amputees (8% and 14% at 60 and 120 degrees /s, respectively), their residual limb being slightly stronger. Inactive TT amputees demonstrated up to 49% strength asymmetry, their intact limb being the stronger. Active TT amputees demonstrated greater peak hip torques (Nm/kg) for all conditions and speeds compared to inactive TT amputees. Peak hip torques (Nm/kg), were greater in the active TT amputees' residual limb compared to AB. While inactive TT amputees and AB had similar flexion/extension ratios, active TT amputees exhibited a lower ratio indicating overdeveloped hip extensors with respect to their hip flexors. It is not known whether this is due to the demands of sport or exercise with a prosthetic limb, or remaining residual thigh atrophy.

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Normalization alters the interpretation of hip strength in established unilateral lower limb prosthesis users

Sawers

Fatone

2022

Clinical Biomechanics

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Leg Muscle Strength in Below-Knee Amputees

Cited by 7 publications

References 1 publication

Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss

Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss

Lower Limb Strength in Sports-Active Transtibial Amputees

Normalization alters the interpretation of hip strength in established unilateral lower limb prosthesis users

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