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Energy expenditure during over ground walking in paediatric amputees
Oral Presentations / Gait & Posture 24S (2006) S7–S97
S59
lations (KD) and above knee amputations (AKA) are within normal range during SSW.
2. Introduction
Fig. 4. Prosthetic evaluation questionnaire.
consumption [2,3,5]. The current study, performed on the OttoBock C-Leg, found similar results. Individuals using a microprocessor-controlled knee demonstrate improvements in gait and balance with a concomitant decrease in energy consumption. These positive changes translate into increased activity in the users’ daily life.
References [1] [2] [3] [4] [5] [6]
Kirker S, et al. Clin Rehabil 1996;10:267–73. Taylor MB, et al. Prosthet Orthot Int 1996;20:116–21. Buckley JG, et al. Arch Phys Med Rehabil 1997;78:330. Datta D, et al. Prosthet Orthot Int 1998;22:129–35. Schmalz T, et al. Gait Post 2002;16:255–63. Johansson JL, et al. Am L Phys Med Rehabil 2005;84(8):563–75.
doi:10.1016/j.gaitpost.2006.11.042 O-35 Energy expenditure during over ground walking in paediatric amputees K.A. Jeans ∗ , L.A. Karol Texas Scottish Rite Hospital for Children, Dallas, TX, USA
1. Summary/conclusions Results for self selected walking (SSW) in children with lower extremity amputation show that amputees of all levels tend to reduce their walking speed (a significant decrease was found in the hip disarticulation (HD) group), but the cost of ambulation and heart rate (HR) are only significantly increased in the HD group, compared to normal. Our study fails to support previous adult research that shows that as the level of amputation ascends the leg, energy cost and HR increase while SSW velocity decreases. This study demonstrates that although amputees choose to walk at a slightly slower SSW speed, the energy cost and HR of participants with Symes, below knee amputations (BKA), knee disarticu-
In reviewing the amputee literature regarding energy expenditure, it is clear that the adult population is well described [1], but less information can be found on the paediatric population. Herbert et al. compared children with BKA to normal during treadmill walking at self selected speed and found that patients with BKA were able to maintain similar walking speed but had significantly higher energy costs than patients with intact limbs [2]. They did not find significant differences in HR, as the adult literature reports [1]. Ashley et al. measured HR and SSW velocity in children with Symes, BKA, KD and AKA and found that all groups walked at a slightly decreased speed, with an increased HR [3].
3. Statement of clinical significance It is unclear if the results reported in the adult literature can be directly related to the paediatric population at multiple levels of amputation. The purpose of this study is to compare the energy efficiency of children with lower extremity amputation between groups and to age matched normals.
4. Methods Unilateral amputees over the age of five were invited to participate in this IRB approved study. Exclusion criteria for testing included: prosthetic use of less than 6 months, prosthetic complications and skin breakdown. All participants were required to refrain from eating two hours prior to testing. Oxygen consumption was collected using the K4 b2 oxygen analysis telemetry unit (Cosmed, Rome, Italy). A 5 min seated rest period was collected prior to a 10 min walk at a self selected speed around a 40 m track. One minute of steadystate data was selected from rest and SSW, and reduced. Patients were grouped according to level of amputation: Symes, BKA, KD, AKA and HD. Each amputee was then compared to the appropriate group of age matched normals: child 6–12 years or teen 13–19 years. Variables analyzed were resting VO2 rate (ml/kg/min), resting HR (bpm), VO2 Cost (ml/kg/m), HR (bpm) and velocity (m/min). A Tukey post hoc multiple comparison procedure was run to compare amputee levels and to compare amputees with normal. The overall error rate is controlled at 0.05.
5. Results Forty-three unilateral amputees and 39 normal children participated in this study. Subject demographics can be seen
S60
Oral Presentations / Gait & Posture 24S (2006) S7–S97
Table 1 Demographics of amputees and normal child/teen
Age (year) BM (kg) BMI (kg/m2 ) *
Symes n = 17
BKA n = 10
KD n = 9
AKA n = 4
HD n = 3
Normal child n = 23
Normal teen n = 16
11.1 (±2.7) 49.6 (±19.6) 21.1 (±5.6)*
11.2 (±4.1) 45.6 (±23.4) 19.3 (±4.9)
14.3 (±3.6) 56.8 (±10.4) 21.0 (±2.6)
15.5 (±2.6) 66.4 (±22.1) 21.1 (±4.2)
12.3 (±5.5) 40.9 (±16.4) 18.9 (±0.9)
10.0 (±1.6) 35.6 (±7.5) 16.8 (±2.1)
15.4 (±1.8) 66.0 (±21.0) 22.6 (±6.5)
Statistically different from age matched normals.
References [1] Waters RL, Mulroy S. Gait Post 1999;9:207–31. [2] Herbert LM, et al. Phys Ther 1994;74(10):943–50. [3] Ashley RK, et al. Orthopaed Rev 1992;21(6):745–9.
doi:10.1016/j.gaitpost.2006.11.043 O-36 High failure rates when avoiding unexpected obstacles while walking in patients with a trans-tibial amputation Cheriel J. Hofstad a,c,∗ , Harmen Van der Linde a , Bart Nienhuis a , Vivian Weerdesteyn a,c , Jacques Duysens a,b,c , Alexander C. Geurts a,b Fig. 1. Statistically different than: (
) normal, () HD and ( ) Symes.
in Table 1. All amputees were age matched and compared to the appropriate group. The Symes group had significantly higher BMI than normal. No other differences were found in anthropometrics, or in resting VO2 rate or resting HR. An analysis of VO2 Cost, walking velocity and HR was conducted comparing between amputee groups, and normal. Data is presented in Fig. 1 as a percent of age matched normal. Amputee group comparisons show that AKA and HD have higher VO2 Cost than Symes, and HD have significantly higher HR than the Symes and KD groups during SSW. The Symes, BKA, KD and AKA groups were not statistically different than normal for VO2 Cost, SSW velocity or HR. The HD group had significantly higher VO2 Cost and HR while the SSW velocity was significantly slower, than normal. An overall trend can be seen in Fig. 1 for increasing VO2 Cost and decreasing SSW velocity, with amputation level.
a
Sint Maartenskliniek Research Development & Education, Nijmegen, the Netherlands b Department of Rehabilitation Medicine, University Medical Center St. Radboud, Nijmegen, the Netherlands c IFKB, Institute for Fundamental and Clinical Human Movement Sciences, the Netherlands
1. Conclusions Patients with a lower leg prosthesis show significantly higher failure rates than control subjects when avoiding sudden obstacles. Under time pressure, the patients perform best when they use their non-prosthetic leg as the lead limb in a short step strategy (SSS). Some of the more experienced prosthesis users made no errors at all, which suggests that over many years it is still possible to relearn the appropriate avoidance reactions sufficiently fast.
2. Introduction 6. Discussion The Waters series of adult amputees show that energy expenditure increases and walking speed decreases with the level of amputation for traumatic, surgical and vascular amputees. Although this study shows a trend for increased VO2 Cost with increased level of amputation, the data shows that paediatric amputees maintain a slightly slower walking speed, but do not show a significant increase in energy cost or in HR until amputation occurs at the hip.
Individuals with a lower leg prosthesis due to a trans-tibial amputation have no muscle control about the artificial ankle and suffer from absent propriocepsis from the ankle joint and lower leg muscles as well as from absent exterocepsis from the foot sole. Individuals with a trans-tibial amputation may experience difficulties not only with unperturbed standing and walking, but especially with avoiding obstacles [1] which increases their risk of falling. In daily life, obstacles often occur suddenly requiring fast, more or less automatic responses. In this perspective, we addressed the
S59
lations (KD) and above knee amputations (AKA) are within normal range during SSW.
2. Introduction
Fig. 4. Prosthetic evaluation questionnaire.
consumption [2,3,5]. The current study, performed on the OttoBock C-Leg, found similar results. Individuals using a microprocessor-controlled knee demonstrate improvements in gait and balance with a concomitant decrease in energy consumption. These positive changes translate into increased activity in the users’ daily life.
References [1] [2] [3] [4] [5] [6]
Kirker S, et al. Clin Rehabil 1996;10:267–73. Taylor MB, et al. Prosthet Orthot Int 1996;20:116–21. Buckley JG, et al. Arch Phys Med Rehabil 1997;78:330. Datta D, et al. Prosthet Orthot Int 1998;22:129–35. Schmalz T, et al. Gait Post 2002;16:255–63. Johansson JL, et al. Am L Phys Med Rehabil 2005;84(8):563–75.
doi:10.1016/j.gaitpost.2006.11.042 O-35 Energy expenditure during over ground walking in paediatric amputees K.A. Jeans ∗ , L.A. Karol Texas Scottish Rite Hospital for Children, Dallas, TX, USA
1. Summary/conclusions Results for self selected walking (SSW) in children with lower extremity amputation show that amputees of all levels tend to reduce their walking speed (a significant decrease was found in the hip disarticulation (HD) group), but the cost of ambulation and heart rate (HR) are only significantly increased in the HD group, compared to normal. Our study fails to support previous adult research that shows that as the level of amputation ascends the leg, energy cost and HR increase while SSW velocity decreases. This study demonstrates that although amputees choose to walk at a slightly slower SSW speed, the energy cost and HR of participants with Symes, below knee amputations (BKA), knee disarticu-
In reviewing the amputee literature regarding energy expenditure, it is clear that the adult population is well described [1], but less information can be found on the paediatric population. Herbert et al. compared children with BKA to normal during treadmill walking at self selected speed and found that patients with BKA were able to maintain similar walking speed but had significantly higher energy costs than patients with intact limbs [2]. They did not find significant differences in HR, as the adult literature reports [1]. Ashley et al. measured HR and SSW velocity in children with Symes, BKA, KD and AKA and found that all groups walked at a slightly decreased speed, with an increased HR [3].
3. Statement of clinical significance It is unclear if the results reported in the adult literature can be directly related to the paediatric population at multiple levels of amputation. The purpose of this study is to compare the energy efficiency of children with lower extremity amputation between groups and to age matched normals.
4. Methods Unilateral amputees over the age of five were invited to participate in this IRB approved study. Exclusion criteria for testing included: prosthetic use of less than 6 months, prosthetic complications and skin breakdown. All participants were required to refrain from eating two hours prior to testing. Oxygen consumption was collected using the K4 b2 oxygen analysis telemetry unit (Cosmed, Rome, Italy). A 5 min seated rest period was collected prior to a 10 min walk at a self selected speed around a 40 m track. One minute of steadystate data was selected from rest and SSW, and reduced. Patients were grouped according to level of amputation: Symes, BKA, KD, AKA and HD. Each amputee was then compared to the appropriate group of age matched normals: child 6–12 years or teen 13–19 years. Variables analyzed were resting VO2 rate (ml/kg/min), resting HR (bpm), VO2 Cost (ml/kg/m), HR (bpm) and velocity (m/min). A Tukey post hoc multiple comparison procedure was run to compare amputee levels and to compare amputees with normal. The overall error rate is controlled at 0.05.
5. Results Forty-three unilateral amputees and 39 normal children participated in this study. Subject demographics can be seen
S60
Oral Presentations / Gait & Posture 24S (2006) S7–S97
Table 1 Demographics of amputees and normal child/teen
Age (year) BM (kg) BMI (kg/m2 ) *
Symes n = 17
BKA n = 10
KD n = 9
AKA n = 4
HD n = 3
Normal child n = 23
Normal teen n = 16
11.1 (±2.7) 49.6 (±19.6) 21.1 (±5.6)*
11.2 (±4.1) 45.6 (±23.4) 19.3 (±4.9)
14.3 (±3.6) 56.8 (±10.4) 21.0 (±2.6)
15.5 (±2.6) 66.4 (±22.1) 21.1 (±4.2)
12.3 (±5.5) 40.9 (±16.4) 18.9 (±0.9)
10.0 (±1.6) 35.6 (±7.5) 16.8 (±2.1)
15.4 (±1.8) 66.0 (±21.0) 22.6 (±6.5)
Statistically different from age matched normals.
References [1] Waters RL, Mulroy S. Gait Post 1999;9:207–31. [2] Herbert LM, et al. Phys Ther 1994;74(10):943–50. [3] Ashley RK, et al. Orthopaed Rev 1992;21(6):745–9.
doi:10.1016/j.gaitpost.2006.11.043 O-36 High failure rates when avoiding unexpected obstacles while walking in patients with a trans-tibial amputation Cheriel J. Hofstad a,c,∗ , Harmen Van der Linde a , Bart Nienhuis a , Vivian Weerdesteyn a,c , Jacques Duysens a,b,c , Alexander C. Geurts a,b Fig. 1. Statistically different than: (
) normal, () HD and ( ) Symes.
in Table 1. All amputees were age matched and compared to the appropriate group. The Symes group had significantly higher BMI than normal. No other differences were found in anthropometrics, or in resting VO2 rate or resting HR. An analysis of VO2 Cost, walking velocity and HR was conducted comparing between amputee groups, and normal. Data is presented in Fig. 1 as a percent of age matched normal. Amputee group comparisons show that AKA and HD have higher VO2 Cost than Symes, and HD have significantly higher HR than the Symes and KD groups during SSW. The Symes, BKA, KD and AKA groups were not statistically different than normal for VO2 Cost, SSW velocity or HR. The HD group had significantly higher VO2 Cost and HR while the SSW velocity was significantly slower, than normal. An overall trend can be seen in Fig. 1 for increasing VO2 Cost and decreasing SSW velocity, with amputation level.
a
Sint Maartenskliniek Research Development & Education, Nijmegen, the Netherlands b Department of Rehabilitation Medicine, University Medical Center St. Radboud, Nijmegen, the Netherlands c IFKB, Institute for Fundamental and Clinical Human Movement Sciences, the Netherlands
1. Conclusions Patients with a lower leg prosthesis show significantly higher failure rates than control subjects when avoiding sudden obstacles. Under time pressure, the patients perform best when they use their non-prosthetic leg as the lead limb in a short step strategy (SSS). Some of the more experienced prosthesis users made no errors at all, which suggests that over many years it is still possible to relearn the appropriate avoidance reactions sufficiently fast.
2. Introduction 6. Discussion The Waters series of adult amputees show that energy expenditure increases and walking speed decreases with the level of amputation for traumatic, surgical and vascular amputees. Although this study shows a trend for increased VO2 Cost with increased level of amputation, the data shows that paediatric amputees maintain a slightly slower walking speed, but do not show a significant increase in energy cost or in HR until amputation occurs at the hip.
Individuals with a lower leg prosthesis due to a trans-tibial amputation have no muscle control about the artificial ankle and suffer from absent propriocepsis from the ankle joint and lower leg muscles as well as from absent exterocepsis from the foot sole. Individuals with a trans-tibial amputation may experience difficulties not only with unperturbed standing and walking, but especially with avoiding obstacles [1] which increases their risk of falling. In daily life, obstacles often occur suddenly requiring fast, more or less automatic responses. In this perspective, we addressed the