The influence of traumatic transfemoral amputation on metabolic cost across walking speeds

Esposito, Elizabeth Russell; Rábago, Christopher A.; Wilken, Jason M.

doi:10.1177/0309364617708649

Cited by 28 publications

(11 citation statements)

References 49 publications

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“…Even oxygen cost was the same at the same velocity with energy storing and return [90]. Another recent study on TFAs with a mix of N‐MPK and P‐MPK reports 8.6% slower walking speed and 46% greater metabolic cost compared to age‐matched nonamputee individuals [91].…”

Section: Discussionmentioning

confidence: 99%

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Lechler

Frossard

Whelan

et al. 2018

PM&R

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People with major limb amputations are severely impaired when it comes to activity, body structure and function, as well as participation. Demographic statistics predict a dramatic increase of this population and additional challenges with their increasing age and higher levels of amputation. Prosthetic use has been shown to have a positive impact on mobility and depression, thereby affecting the quality of life. Biomechatronic prostheses are at the forefront of prosthetic development. Actively powered designs are now regularly used for upper limb prosthetic fittings, whereas for lower limbs the clinical use of actively powered prostheses has been limited to a very low number of applications. Actively powered prostheses enhance restoration of the lost physical functions of an amputee but are yet to allow intuitive user control. This paper provides a review of the status of biomechatronic developments in upper and lower limb prostheses in the context of the various challenges of amputation and the clinically relevant outcomes. Whereas most of the evidence regarding lower limb prostheses addresses biomechanical issues, the evidence for upper limb prostheses relates to activities of daily living (ADL) and instrumental ADL through diverse outcome measures and tools.

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Section: Discussionmentioning

confidence: 99%

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Lechler

Frossard

Whelan

et al. 2018

PM&R

View full text Add to dashboard Cite

show abstract

“…In context, a major challenge is to increase ankle push-off power during walking [ 8 , 9 ]. Unfortunately, passive prostheses cannot provide a sufficient range of motion and net positive joint work, which induces asymmetrical limb loading, altered gait and daily activity patterns compared to able-bodied individuals [ 9 – 15 ]. To improve prosthetic functioning, reduce injuries and improve quality of life, a new passive ankle–foot prosthesis (i.e.…”

Section: Introductionmentioning

confidence: 99%

Continuous relative phases of walking with an articulated passive ankle–foot prosthesis in individuals with a unilateral transfemoral and transtibial amputation: an explorative case–control study

et al. 2023

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Background A mechanical ankle–foot prosthesis (Talaris Demonstrator) was developed to improve prosthetic gait in people with a lower-limb amputation. This study aims to evaluate the Talaris Demonstrator (TD) during level walking by mapping coordination patterns based on the sagittal continuous relative phase (CRP). Methods Individuals with a unilateral transtibial amputation, transfemoral amputation and able-bodied individuals completed 6 minutes of treadmill walking in consecutive blocks of 2 minutes at self-selected (SS) speed, 75% SS speed and 125% SS speed. Lower extremity kinematics were captured and hip–knee and knee–ankle CRPs were calculated. Statistical non-parametric mapping was applied and statistical significance was set at 0.05. Results The hip–knee CRP at 75% SS walking speed with the TD was larger in the amputated limb of participants with a transfemoral amputation compared to able-bodied individuals at the beginning and end of the gait cycle (p = 0.009). In people with a transtibial amputation, the knee–ankle CRP at SS and 125% SS walking speeds with the TD were smaller in the amputated limb at the beginning of the gait cycle compared to able-bodied individuals (p = 0.014 and p = 0.014, respectively). Additionally, no significant differences were found between both prostheses. However, visual interpretation indicates a potential advantage of the TD over the individual's current prosthesis. Conclusion This study provides lower-limb coordination patterns in people with a lower-limb amputation and reveals a possible beneficial effect of the TD over the individuals’ current prosthesis. Future research should include a well-sampled investigation of the adaptation process combined with the prolonged effects of the TD.

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“…Unfortunately, those passive ankle–foot prostheses are still unable to mimic able-bodied performance during daily activities as they fail to provide sufficient range of motion and net positive joint work [ 6 , 7 ]. This induces higher metabolic energy consumption during daily activities, asymmetrical limb loading, and altered gait patterns compared to able-bodied individuals [ 8 – 10 ]. Quasi-passive prostheses are also mechanical but equipped with microprocessor technology enabling them to adapt to situations such as walking on an inclined surface [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an articulated passive ankle–foot prosthesis

et al. 2022

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Background Current ankle prostheses for people with unilateral transtibial amputation (TTA) or transfemoral amputation (TFA) are unable to mimic able-bodied performance during daily activities. A new mechanical ankle–foot prosthesis was developed to further optimise the gait of people with a lower-limb amputation. This study aimed to evaluate the Talaris Demonstrator (TD) during daily activities by means of performance-related, physiological and subjective outcome measures. Materials and methods Forty-two participants completed a protocol assessing performance and functional mobility with their current prosthesis and the TD. The protocol comprised the L-test, 2 min of stair climbing, 2 min of inclined treadmill walking, 6 min of treadmill walking at 3 different speeds in consecutive blocks of 2 min, and a 3-m Backward Walk test (3mBWT). Heart rate was measured during each task, and oxygen uptake was collected during all tasks except for the L-test and 3mBWT. Time of execution was recorded on the L-test and 3mBWT, and the rate of perceived exertion (score = 6–20), fatigue and comfort (score = 0–100) were assessed after each task. Paired sample t-tests and Wilcoxon Signed-rank tests were performed to compare outcomes between prosthetic devices. Benjamini–Hochberg corrections were applied to control for multiple comparisons with a level of significance set at α = 0.05. Results Subjects with a TTA (N = 28) were faster with their current prosthesis compared to the TD on the L-test and 3mBWT (p = 0.005). In participants with a TFA (N = 14), we observed a tendency towards a higher heart rate during the L-test and towards increased comfort during inclined walking, with the TD compared to the participants’ current prosthetic device (0.05 < p < 0.10). Further, no significant results were observed. Conclusion The Talaris Demonstrator is a novel state-of-the-art passive ankle–foot prosthesis for both people with a TTA and TFA. Subjective measures indicate the added value of this device, while overall task performance and intensity of effort do not differ between the Talaris Demonstrator and the current prosthesis. Further investigations unravelling both acute and more prolonged adaptations will be conducted to evaluate the TD more thoroughly.

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The influence of traumatic transfemoral amputation on metabolic cost across walking speeds

Cited by 28 publications

References 49 publications

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Continuous relative phases of walking with an articulated passive ankle–foot prosthesis in individuals with a unilateral transfemoral and transtibial amputation: an explorative case–control study

Evaluation of an articulated passive ankle–foot prosthesis

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