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 WHICH IS THE BEST WAY TO PERFORM THE PHYSIOLOGICAL COST INDEX IN ACTIVE INDIVIDUALS WITH UNILATERAL TRANS-TIBIAL AMPUTATION?

2019 ◽  
Author(s):  
Stefano Brunelli ◽  
Andrea Sancesario ◽  
Marco Iosa ◽  
Anna Sofia Delussu ◽  
Noemi Gentileschi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Energy Expenditure ◽  
Energy Cost ◽  
Limb Amputation ◽  
Alternative Measure ◽  
Cost Index ◽  
Physiological Cost ◽  
Fitness Training ◽  
Energy Cost Of Walking

BACKGROUND: Physiological Cost Index (PCI) is a simple method used to estimate energy expenditure during walking. It is based on a ratio between heart rate and self-selected walking speed. Previous studies reported that PCI is reliable in individuals with lower limb amputation but only if there is an important walking impairment. No previous studies have investigated the correlation of PCI with the Energy Cost Walking (ECW) in active individuals with traumatic unilateral trans-tibial amputation, considering that this particular category of amputees has an ECW quite similar to healthy individual without lower limb amputation. Moreover, it is important to determine if PCI is also correlated to ECW in the treadmill test so as to have an alternative to over-ground test. OBJECTIVES: The aim of this study was to evaluate the correlation between PCI and ECW in active individuals with traumatic trans-tibial amputation in different walking conditions. The secondary aim was to evaluate if this correlation permits to determine ECW from PCI values. METHODOLOGY: Ninety traumatic amputees were enrolled. Metabolic data, heart rate and walking speed for the calculation of ECW and for PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test. FINDINGS: There is a significant correlation between ECW and PCI walking over-ground (p=0.003; R2=0.10) and on treadmill with 12% slopes (p=0.001; R2=0.11) but there is only a poor to moderate correlation around the trendline. No significant correlation was found walking on treadmill with 0% slope. The Bland-Altman plot analysis suggests that is not possible to evaluate ECW directly from PCI. CONCLUSIONS: PCI is a reliable alternative measure of energy expenditure during walking in active individuals with trans-tibial amputation when performing over-ground or at high intensity effort on treadmill. PCI is therefore useful only for monitoring a within subject assessment. LAYMAN’S ABSTRACT The knowledge of the energy cost of walking in disabled people is important to improve strategies of rehabilitation or fitness training and to develop new prosthetic and orthotic components. The “gold standard” for the evaluation of the energy cost of walking is the oxygen consumption measurement with a metabolimeter, but the testing procedure is expensive and time consuming, hardly practicable in many rehabilitation centers. The Physiological Cost Index (PCI) is an indirect tool that evaluates the oxygen consumption during walking. PCI considers heart rate during walking, in relation to the speed, as an indicator of energy expenditure. The formula is “walking heart rate – resting heart rate /speed”. PCI is widely used in literature but there is not a solid evidence of a direct correlation between PCI and energy cost of walking. In particular, for individuals with unilateral trans-tibial amputation without comorbidities, no previous studies have been conducted about this correlation. It has to be noticed that individuals with unilateral trans-tibial amputation have an energy cost of walking quite similar to healthy people. Previous studies reported that in healthy people such correlation does not exist. For this reason, the aim of this study was to evaluate if and in which walking condition a linear correlation exists between PCI and Energy Cost Walking in individuals with unilateral trans-tibial amputation. Oxygen consumption measurement with a metabolimeter and PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test in 90 participants. We have found that PCI is an alternative measure of energy cost of walking when performing over-ground or with high intensity effort on treadmill (12% slope). These findings could be useful when PCI is used for monitoring a fitness training or for evaluation tests. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32953/25717 How to Cite: Brunelli S, Sancesario A, Iosa M, Delussu A.S, Gentileschi N, Bonanni C, Foti C, Traballesi M. Which is the best way to perform the Physiological Cost Index in active individuals with unilateral trans-tibial amputation? Canadian Prosthetics & Orthotics Journal. Volume2, Issue1, No.5, 2019. https://doi.org/10.33137/cpoj.v2i1.32953. CORRESPONDING AUTHOR: Dr. Stefano Brunelli,Fondazione Santa Lucia, IRCCS, Via Ardeatina 306, 00179 Rome, Italy.ORCID: https://orcid.org/0000-0002-5986-1564Tel. +39 0651501844; Fax +39 0651501919E-MAIL: [email protected]

The effect of trunk extension on physiological cost index in spinal cord injury patients when using the advanced reciprocating gait orthosis: A pilot study

2016 ◽  
Vol 40 (6) ◽  
pp. 696-702 ◽  
Author(s):  
Mokhtar Arazpour ◽  
Mohammad Samadian ◽  
Mahmood Bahramizadeh ◽  
Monireh Ahmadi Bani ◽  
Masoud Gharib ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Walking Speed ◽  
Well Being ◽  
Walking Distance ◽  
Cost Index ◽  
Physiological Cost ◽  
Cord Injury ◽  
Trunk Extension

Background:People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users.Objective:The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension.Study design:Quasi experimental study.Methods:Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate.Results:Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ.Conclusion:Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis.Clinical relevanceIt is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

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.

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.

The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1Spinal Cord Injury

2009 ◽  
Vol 33 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Aaron K. L. Leung ◽  
Admond F. Y. Wong ◽  
Eunice C. W. Wong ◽  
Stephen W. Hutchins
Keyword(s):  
Spinal Cord ◽  
Heart Rate ◽  
Walking Speed ◽  
Cost Index ◽  
Spinal Cord Lesions ◽  
Heart Rate Monitor ◽  
Physiological Cost ◽  
Cord Injury ◽  
Stop Watch ◽  
Ankle Foot Orthoses

Objective: The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T12 – L1spinal cord lesions.Methodology: Six chronic paraplegic subjects who had T12 – L1spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison.Results: Ambulation using the IRGO (10.46 +/− 2.00 m/min) was significantly faster ( p = 0.009) than ambulation using the bilateral KAFOs (5.51 +/− 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 +/− 0.77 beats/m) was significantly lower ( p = 0.0306) than that of the bilateral KAFOs (6.77 +/− 3.28 beats/m).Conclusion: Paraplegic patients with T12 – L1spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.

scholarly journals The physiological cost index of walking with a powered knee–ankle–foot orthosis in subjects with poliomyelitis: A pilot study

2015 ◽  
Vol 40 (4) ◽  
pp. 454-459 ◽  
Author(s):  
Mokhtar Arazpour ◽  
Monireh Ahmadi Bani ◽  
Mohammad Samadian ◽  
Mohammad E Mousavi ◽  
Stephen W Hutchins ◽  
...  
Keyword(s):  
Walking Speed ◽  
Knee Joints ◽  
Cost Index ◽  
Ankle Foot Orthosis ◽  
Physiological Cost ◽  
Active Flexion ◽  
Quasi Experimental ◽  
Locked Knee ◽  
Foot Orthosis ◽  
Flexion And Extension

Background: A powered knee–ankle–foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. Objective: The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee–ankle–foot orthosis with drop lock knee joints. Study design: Quasi experimental study. Methods: Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee–ankle–foot orthosis. Results: Walking with the powered knee–ankle–foot orthosis significantly reduced walking speed ( p = 0.015) and the distance walked ( p = 0.004), and also, it did not improve physiological cost index values ( p = 0.009) compared to walking with the locked knee–ankle–foot orthosis. Conclusion: Using a powered knee–ankle–foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. Clinical relevance This powered knee–ankle–foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee–ankle–foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted.

An Incremental Shuttle Walk Test to Estimate Maximal Aerobic Functional Capacity

2007 ◽  
Vol 30 (3) ◽  
pp. 38
Author(s):  
Sébastien Duvergé ◽  
Mario Leone ◽  
Émilia Kalinova ◽  
Frédéric Le Cren ◽  
Jean P. Boucher ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Rate ◽  
Functional Capacity ◽  
Walking Speed ◽  
Peak Oxygen Consumption ◽  
Walk Test ◽  
Strong Correlations ◽  
Maximum Heart Rate ◽  
Walking Test ◽  
Metabolic Cart

Background: The goal of the present study was to compare the maximum walking speed and peak oxygen consumption (VO2 peak) obtained during the 6-min walk test (6 MWT) and an incremental shuttle walking test (ISWT) in a trained older population. Methods: A total of 22 older adults (16 female and 6 male) with a group mean age of 70±5.8 yr (range 58 to 79) completed the 6 MWT and ISWT within a 2 wk period. Heart rate (HR) and VO2 peak were measured during each test with a portable metabolic cart (Cosmed, K4B2). The VO2 peak, the maximum walking speed and the total distance walked measured during both tests (6 MWT and ISWT) were compared. Results: A total of 110 recordings for the VO2 peak were obtained and analyzed. Strong correlations were found for the VO2 peak and the walking speed (r=0.91 and r=0.89, respectively, for 6 MWT and ISWT). VO2 peak values obtained with the ISWT were significantly greater (P < 0.05) than with the 6 MWT (21.6 ± 5.3 vs 18.9 ml/kgmin ± 4.5, respectively). There was no difference between sexes. In addition, the maximum heart rate as predicted from age during the ISWT was reached by all participants while it was not during the 6 MWT. Conclusion: Thus, the ISWT appears to a better tool to assess the maximal aerobic functional capacity in older healthy adults based on the higher VO2 peak values obtained in comparison to the 6 MWT.

A Multicenter Trial of a Footdrop Stimulator Controlled by a Tilt Sensor

2006 ◽  
Vol 20 (3) ◽  
pp. 371-379 ◽  
Author(s):  
Richard B. Stein ◽  
SuLing Chong ◽  
Dirk G. Everaert ◽  
Robert Rolf ◽  
Aiko K. Thompson ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Walking Speed ◽  
Multicenter Trial ◽  
Training Effect ◽  
Cost Index ◽  
Physiological Cost ◽  
Central Nervous System Disorders ◽  
Straight Line ◽  
Tilt Sensor ◽  
Over Time

Objectives. To test the efficacy and acceptance of a footdrop stimulator controlled by a tilt sensor. Methods. A nonrandomized, test-retest study of 26 subjects with footdrop of more than 1 year’s duration, resulting from various central nervous system disorders, was performed in 4 centers for at least 3 months. Speed of walking in a straight line, speed around a figure of 8, and physiological cost index (PCI) were measured with and without the device. Hours/day and steps/day using the device were recorded. Results.All but 2 subjects used the tilt sensor at home, rather than a foot switch. Walking speed increased by 15% after 3 months ( n = 26; P < 0.01), 32% after 6 months ( n = 16; P < 0.01), and 47% after 12 months ( n = 8; P < 0.05), while PCI decreased. The number of steps taken per day of use increased significantly over time, and increased speed was directly correlated with usage. Walking speed also increased with the stimulator off, but to a lesser extent, indicating a training effect. Subject feedback from a questionnaire indicated satisfaction with the stimulator. Conclusions. Both efficacy and acceptance of the stimulator were good in a population of subjects with chronic footdrop.

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