Improvement in walking abilities in transfemoral amputees with a distal weight bearing implant

2016 ◽  
Vol 41 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Lluis Guirao ◽  
C Beatriz Samitier ◽  
Maria Costea ◽  
Josep Maria Camos ◽  
Maria Majo ◽  
...  
Keyword(s):  
Gait Speed ◽  
Weight Bearing ◽  
Titanium Implant ◽  
Walk Test ◽  
Transfemoral Amputation ◽  
Post Intervention ◽  
Cost Index ◽  
Physiological Cost ◽  
The Mean ◽  
Distal Support

Background:The ability to walk with a prosthesis is the main objective of rehabilitation following amputation, and distance and speed of walking achieved are considered determining factors in amputees’ perception of quality-of-life.Objectives:To assess walking abilities and improvement in gait distance and speed parameters in patients undergoing transfemoral amputation with a femoral implant that allows distal support of the residuum.Study design:Experimental before-and-after study.Methods:Ten transfemoral amputation patients received a titanium implant that allowed distal weight bearing of the residuum within the socket. The post-intervention follow-up period was 14 months. We evaluated the functionality using a 2-min walk test and the physiological cost index.Results:The etiology of amputation was traumatic in six patients (60%). The mean 2-min walk test score was 98.4 ± 19.5 m prior to the femoral implant and 122.5 ± 26.1 m at 14 months ( p < 0.008), representing an improvement of 24.5%. The mean gait speed prior to the femoral implant was 0.82 ± 0.16 and 1.02 ± 0.21 m/s at 14 months ( p < 0.008). The physiological cost index showed no differences ( p < 0.55).Conclusion:The results of this study show an improvement in the distance walked and gait speed in amputees 14 months after having received a femoral implant.Clinical relevanceThis article provides additional insight into the use of a femoral implant that allows distal support of the residuum to improve walking abilities and gait distance and speed parameters in patients undergoing transfemoral amputation, mainly those of vascular origin.

scholarly journals The Effect of Lower Leg Casting on Energy Cost During Independent Ambulation: Considerations for Clinical Practice

2014 ◽  
Author(s):  
Cindy LaPorte ◽  
Daie Johnson ◽  
Kiersten Koen ◽  
Lena Hardy ◽  
Valda Montgomery
Keyword(s):  
Heart Rate ◽  
Energy Cost ◽  
Gait Speed ◽  
Walking Speed ◽  
Lower Leg ◽  
Walk Test ◽  
Resting Heart Rate ◽  
Cost Index ◽  
Physiological Cost ◽  
Independent Ambulation

Purpose: The purpose of this study was to investigate the effects of dominant leg, lower leg casting on energy cost during independent ambulation. The Physiological Cost Index, predicted VO2max, and gait speed values of a Quarter-Mile Walk Test, with and without lower leg casting, were utilized to determine energy cost. Methods: Thirty-five subjects who were 23 to 32 years old (mean age 25.37 ± 2.02) performed the Quarter-Mile Walk Test at their comfortable walking speed on two occasions, one with and one without lower leg casting. Resting heart rate, walking heart rate, and time to complete the test were recorded. Physiological Cost Index, predicted VO2max, and gait speed formulas were used to calculate results.Results: Physiological Cost Index increased when walking with the lower leg cast, but was not statistically significant (p=.3939). A statistically significant decrease was seen with predicted VO2max (p< .0001) and gait speed (p< .0001) when walking with a lower leg cast. Conclusions: Predicted VO2max and gait speed decreased when walking with a lower leg cast on the dominant leg. This finding indicates that as subjects altered their self-selected speed, predicted VO2max decreased with gait speed.

scholarly journals Functional reserve in functionally independent elderly persons: a calculation of gait speed and physiological cost

2016 ◽  
Vol 19 (4) ◽  
pp. 577-589
Author(s):  
Paul Medina González ◽  
Rodrigo Muñoz Cofré ◽  
Máximo Escobar Cabello
Keyword(s):  
Heart Rate ◽  
Gait Speed ◽  
Cross Sectional Study ◽  
Critical Threshold ◽  
Elderly Persons ◽  
Cost Index ◽  
Functional Reserve ◽  
Cross Sectional ◽  
Physiological Cost ◽  
Working Heart

Abstract Aim: To analyze the behavior of functional reserve percentage (%FR) by gender in functional elderly persons, considering speed and the physiological cost of gait. Methods: A total of 53 self-reliant elderly persons, 40 of whom were women (age 69.4±4.7 years old; BMI 31.2±4.3 kg/m2) and 13 of whom were men (age 70.8±7.2 years old; BMI 28.7±3.5 kg/m2) participated in an observational and cross-sectional study. Participants were requested to walk at comfortable (CG) and maximum gait (MG). Both modalities were performed on a 70-meter elliptical circuit over three minutes. Distance and working heart rate were recorded for the corresponding calculation of average gait speed (AGS), physiological cost index (PCI) and used working heart rate percentage (% uWHR). With this information the FR% was determined by the percentage ratio with AGS, PCI and %uWHR under comfortable versus maximum demand walk conditions. Results: The association between %FR and AGS was significantly higher in males (p=0.017), reaching values of +-20% in most subjects. The physiological %FR for PCI was ≈30% in both men and women (p=0.156), while for % uWHR was ≈40% in females and ≈45% in males (p=0.131). Conclusion: AGS is a critical threshold functionality indicator to determine FR in functionally independent Chilean elderly persons.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dorian K Rose ◽  
Lou DeMark ◽  
Christy Conroy ◽  
Emily Fox ◽  
David Clark
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Fall Risk ◽  
Step Length ◽  
Walk Test ◽  
Post Intervention ◽  
Backward Walking ◽  
Balance Confidence ◽  
Post Stroke ◽  
Abc Scale

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p < 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

scholarly journals Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Claudia Ramos Claret ◽  
Georg W. Herget ◽  
Lukas Kouba ◽  
Daniel Wiest ◽  
Jochen Adler ◽  
...  
Keyword(s):  
Postural Control ◽  
Lower Limb ◽  
Sensory Feedback ◽  
Sensorimotor Integration ◽  
Center Of Pressure ◽  
Temporal Structure ◽  
Weight Bearing ◽  
Transfemoral Amputation ◽  
Neuromuscular Adaptations ◽  
The Mean

Abstract Background Following an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation. Methods Center of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG). Results There was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p <  0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p <  0.001), CoP velocity (p <  0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = − 0.59, EC: ρ = − 0.69). Conclusion These results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control. Trial registration DRKS00015254, registered on September 20th, 2018.

The Repeatability of Gait Speed and Physiological Cost Index Measurements in Working Adults

2013 ◽  
Vol 5 (2) ◽  
pp. 128-133 ◽  
Author(s):  
Rishi Raj ◽  
Hoda Mojazi Amiri ◽  
Helen Wang ◽  
Kenneth M. Nugent
Keyword(s):  
Gait Speed ◽  
Cost Index ◽  
Working Adults ◽  
Physiological Cost

scholarly journals Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation

2017 ◽  
Vol 42 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Sara Agueda Fuenzalida Squella ◽  
Andreas Kannenberg ◽  
Ângelo Brandão Benetti
Keyword(s):  
Outcome Measures ◽  
Gait Speed ◽  
Standard Of Care ◽  
Walking Distance ◽  
Walk Test ◽  
Transfemoral Amputation ◽  
Prosthetic Knee ◽  
Balance Confidence ◽  
Highly Active ◽  
Prosthetic Knees

Background:Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes.Objectives:To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees.Study design:Comparative within-subject clinical study.Methods:A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor–enhanced knee.Results:Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions.Conclusion:The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects’ satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees.Clinical relevanceThis study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

Short-term effect of physiotherapy rehabilitation on functional performance of lower limb amputees

2007 ◽  
Vol 31 (3) ◽  
pp. 258-270 ◽  
Author(s):  
B. Rau ◽  
F. Bonvin ◽  
R. de Bie
Keyword(s):  
Usual Care ◽  
Lower Limb ◽  
Functional Performance ◽  
Weight Bearing ◽  
Walk Test ◽  
Cost Index ◽  
Timed Up And Go ◽  
Experimental Group ◽  
Minute Walk ◽  
Lower Limb Amputees

The objective of the trial was to evaluate the effectiveness of a short and intensive physiotherapy programme versus usual care, mainly consisting of walking. Fifty-eight male unilateral lower limb amputees were randomised over intensive care (N = 29) and usual care (N = 29); this study was carried out in a clinical environment, within the premises of the International Committee of the Red Cross, in Southern Myanmar. The amputees in the experimental group received a three-day programme built around 7 specific exercises, lasting approximately one hour altogether. Effects were assessed on: 2-minute walk test, physiological cost index (PCI), amount of weight bearing on both legs, 5 questions of the Functional Measure for Amputees questionnaire and the timed up and go test. Trans-tibial amputees were tested the first day they were fitted and then 2 days later; trans-femoral amputees were tested when walking out of the parallel bars and 4 days later. The experimental group showed significant improvement in the 2-minute walk test (p = 0.02), in the PCI (p = 0.02) and in the maximal weight bearing test on the amputated leg (p = 0.04). Despite limited means, research remains feasible in a developing country; this study has demonstrated that physiotherapy is effective in improving functional performance of lower limb amputees and therefore has its place in every rehabilitation centre.

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