The role of the contralateral limb in below-knee amputee gait

Hurley, Grant; McKenney, R.; Robinson, Mark A.; Zadravec, Matjaž; Pierrynowski, M.R.

doi:10.3109/03093649009080314

Cited by 67 publications

(23 citation statements)

References 9 publications

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“…Studies concerning the outcome of rehabilitation, taking into account the side of amputation, are scarce. Among trans-tibia1 amputees the healthy leg has to compensate for the loss of muscles in the prosthetic leg creating an asymmetric gait (19,20). This makes the healthy leg more active in producing the stabilizing and compensatory effects (21).…”

Section: Discussionmentioning

confidence: 99%

Outcome After Trans-tibial Amputation for Vascular Disease: A Follow-Up After eight Years

Hermodsson¹,

Ekdahl²,

Persson³

1998

Scandinavian Journal of Caring Sciences

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All 112 patients (55 females and 57 males) with a primary unilateral trans-tibial amputation for vascular disease performed in one year at all five hospitals in Malmöhus county, Sweden were examined at 6 months according to the prosthetic function and prospectively followed-up 8 years after the amputation for survival, and prosthetic fitting. The prosthetic function was re-examined among the survivors 8 years postoperatively. At 6 months 50% were fitted with a prosthesis and later (up to 8 years) a further 13%, in total 32 females and 39 males. The mortality at 6 months was 33%, at 2 years 47% and at 8 years 92%. Age at amputation (p = 0.015), to be amputated on the left leg (p = 0.0004), to be able to walk alone outdoors before the amputation (p = 0.007) and not using a wheelchair (p = 0.02) were all found to be statistically significant predictors for receiving a prosthesis. Predictors for good function with the prosthesis 6 months postoperatively was male sex (23 of 57 vs 8 of 55 females) (p = 0.006) and greater ability to walk alone outdoors before the amputation (p = 0.01). There was no significant age difference in this comparison. The finding that it is more favourable to be amputated on the left leg merits further study.

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Section: Discussionmentioning

confidence: 99%

Outcome After Trans-tibial Amputation for Vascular Disease: A Follow-Up After eight Years

Hermodsson¹,

Ekdahl²,

Persson³

1998

Scandinavian Journal of Caring Sciences

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“…Dahingegen zeigen auch Studien reduzierte Kräfte am kontralateralen Bein, bspw. Hurley et al [49], wodurch es fraglich erscheint, ob die vermehrte kontralaterale Belastung beim Gehen mit der Prothese tatsächlich als alleinige Ursache der erhöhten Gonarthroseprävalenz betrachtet werden kann. Hinzu kommt außerdem, dass die veränderte biomechanische Charakteristik beim Gehen [28,38] nur schwer als Ursache für die Gonarthrose anzusehen ist, da nicht zweifelsfrei klar ist, was Ursache und was Wirkung ist.…”

Section: Gonarthroseunclassified

Veränderungen am Bewegungsapparat als Folge von Amputationen an der unteren Extremität

Pröbsting

Blumentritt

Kannenberg³

2016

Z Orthop Unfall

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It is often assumed that leg amputations result in a greater risk of degenerative changes to the locomotor system. This paper analysed the extent to which this assumption is supported by the scientific literature. In particular, the study analysed the level of risk of various degenerative diseases in amputees. A systematic literature search was conducted in scientific databases on degenerative changes caused by amputations. All pertinent articles were qualitatively analysed; the available quantitative results were summarised and compared to data for the able bodied population. The search yielded 40 publications that met the inclusion criteria. A quantitative summary of the studies showed that 56 % of amputees suffered from back pain, radiographic signs of arthritis were found in the sound knee of 35 % of patients, compared with clinical signs in 33 %. Clinical symptoms of hip osteoarthritis were seen in 15 % of amputees on the prosthetic side and in 20 % on the sound side. 87 % of patients exhibited reduced bone density in the hip on the prosthetic side and all amputees exhibited muscular atrophy in the residual limb. Thanks to the development of prosthetic components it is possible to adjust the length of the prosthesis to the length of the sound limb, so that there are no longer discrepancies in leg length. This means that flexion deformities of the spine of amputees have become rarer and are therefore no longer discussed in the current literature. The risks of back pain, knee osteoarthritis in the sound side, reduced bone density on the prosthetic side hip and muscular atrophy are still significantly greater than in the able bodied population. The prevalence of back pain and knee osteoarthritis increases in more proximal amputations. It may be possible to reduce these risks with novel prosthetic components and by optimising prosthetic fitting. On the one hand, an optimised prosthesis willbe used more often. On the other hand, it will be exposed to greater loads and therefore the load to the locomotor system could be distributed more evenly between the two legs. Both aspects would result in a more physiological loading of the locomotor system. There was not enough published evidence to determine to what extent the sound side foot shows degenerative changes.

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“…Such asymmetry suggests that the NAL experiences higher overload than the PL does. To study this hypothesis, Hurley et al 24 analyzed the internal forces of joint reactions in the hips, knees and ankles of unilateral transtibial amputees, and found similar results for the hips, in comparisons between PL and NAL. For the knee and ankle, throughout the stance phase and especially in the first 25% of the cycle, the horizontal reaction forces were greater in the NAL.…”

Section: Biomechanics Of Locomotion For Transtibial Amputeesmentioning

confidence: 99%

Biomechanical parameters of gait among transtibial amputees: a review

Soares

Yamaguti²,

Mochizuki

et al. 2009

Sao Paulo Med. J.

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Rehabilitation for lower-limb amputees needs to focus on restoration of daily functions and independent locomotion. As gait is reestablished, reorganization of the motor pattern takes place in order to optimize the functions of the locomotor system. Biomechanics is a field of study that enables understanding of this reorganization. From such knowledge, appropriate strategies for recovering the autonomy of the means of locomotion can be established. Thus, this paper had the aim of reviewing the current status of the biomechanics of locomotion among unilateral transtibial amputees. To achieve this aim, papers written in English or Portuguese and published up to 2005 were selected from the Cochrane Library, PubMed, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Dedalus databases. In cases of transtibial amputation, the absence of plantar flexors negatively affects locomotion. Increased absorption and energy generation by the muscles that control the hip joint of the amputated leg can be considered to be the main compensatory strategy developed by unilateral transtibial amputees during gait. Factors associated with the characteristics of the amputation, prosthesis and experimental protocol used directly influence the results.

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The role of the contralateral limb in below-knee amputee gait

Cited by 67 publications

References 9 publications

Outcome After Trans-tibial Amputation for Vascular Disease: A Follow-Up After eight Years

Outcome After Trans-tibial Amputation for Vascular Disease: A Follow-Up After eight Years

Veränderungen am Bewegungsapparat als Folge von Amputationen an der unteren Extremität

Biomechanical parameters of gait among transtibial amputees: a review

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