The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study

Abstract

Introduction Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation. Materials and Methods The relationship between temporal-spatial gait asymmetry and metabolic economy (metabolic power normalized by walking speed) was retrospectively examined in eighteen individuals with transfemoral amputation walking at a self-selected velocity overground. Pearson’s product-moment correlations were used to assess the relationship between: (1) step time symmetry and metabolic economy and (2) step length symmetry and metabolic economy. The retrospective analysis of this data was approved by the Walter Reed National Military Medical Center Institutional Review Board and all individuals provided written consent. Additional insights on this relationship are presented through a case series describing the temporal-spatial and metabolic responses of two individuals with transfemoral amputation who completed a split-belt treadmill walking test. Results For the cohort of individuals, there was no significant relationship between metabolic economy and either step time asymmetry or step length asymmetry. However, the case series showed a positive relationship between step length asymmetry and metabolic power as participants adapted to split-belt treadmill walking. Conclusion There is mixed evidence for the relationship between temporal-spatial asymmetries and metabolic energy expenditure. This preliminary study may suggest optimal metabolic energy expenditure in individuals with transfemoral amputation occurs at an individualized level of symmetry and resultant deviations incur a metabolic penalty. The results of this study support the idea that addressing only temporal-spatial gait asymmetries in individuals with transfemoral amputation through rehabilitation may not improve metabolic economy. Nevertheless, future prospective research is necessary to confirm these results and implications for clinical practice.

Walking asymmetry and its relation to patient-reported and performance-based outcome measures in individuals with unilateral lower limb loss

“…Single limb stance and swing phase duration symmetry in particular were related to faster walking speeds and greater average daily steps. That more symmetric gait parallels improved walking speed and energy expenditure has been observed (Darter et al 2013 ) but also contradicted (Yeung et al 2012 ; Mahon et al 2019 ). Some common asymmetries observed in this study, such as reduced single limb stance and terminal double support time with prosthetic-limb trailing, were consistent with reduced double support attributed to limited prosthetic ankle dorsiflexion that inhibits advance of the body over the foot (Carse et al 2020 ).…”

“…Increased walking speeds reduce temporal asymmetry but increase loading asymmetry (Nolan et al 2003 ). The suggestion that gait efficiency measured by energy consumption increases with more symmetric gait was observed in one cohort of people with non-vascular amputation (Darter et al 2013 ) but not supported by other studies in older people with transtibial amputations of mixed causes (Yeung et al 2012 ) or younger military people with traumatic transfemoral amputations (Mahon et al 2019 ). Evidence is also mixed for the suggestion that gait asymmetries in people with limb loss lead to secondary health issues such as knee osteoarthritis and low back pain (Lloyd et al 2010 ; Devan et al 2017 ).…”

Beeinflusst das Tragen einer Gangjustierhilfe in Sicherheitsschuhen die allgemeine Beanspruchung bei Produktionsarbeitern in der Spätschicht?

“…Die Verbesserung des Ganges durch die Symmetrisierung des Gangbilds kann auch zu einer Entlastung führen. Asymmetrisches Gehen ist mit einem höheren Energieaufwand [7,13,14] sowie erhöhtem Sturzrisiko [10,11] [3]. Unterschiedliche HRV-Parameter werden als Goldstandard für die Einschätzung der vegetativen Reaktionen und funktionalen Reserven des Herz-Kreislauf-Systems auf die stattgefundene Belastung in den arbeitsphysiologischen Studien eingesetzt.…”