- Email: [email protected]
Gait strategies of transfemoral amputees descending slopes
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ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
paring injured to non-injured leg for the ACL-injured, or dominant to non-dominant leg for the controls. However, significant differences seem to exist between the two ACL-groups in knee and hip angles both before jump-off (p=0.002, p=0.036, linear mixed model) and after landing (p=0.004, p=0.003, linear mixed model), where ACL-R have larger angles than ACL-PT. Nor were there any differences when comparing angles for the non-injured leg for the ACL-injured and the angles for the legs of the controls. Discussion & Conclusions: Subjects with ACL-injury still show reduced jump capacity in terms of distance in their injured leg about 20 years after injury. In contrast, for the non-injured leg the jump capacity is in parity with that of healthy controls. However, this was not reflected by differences in the kinematic maximum angles of the hip, knee and ankle between injured and non-injured leg for the ACL-groups, which indicates that other parameters than maximal angles taken before jump-off and after landing may be more important to investigate when describing the movement pattern after ACL-injury. Significant differences in knee and hip angles between the two ACL-groups, may indicate different movement pattern depending on treatment approach. Further kinematic analyses are under way to explore the kinematic details of the jump which is needed to quantify the movement patterns after ACLinjury in the long term perspective. http://dx.doi.org/10.1016/j.gaitpost.2013.07.055 O42 The role of the intact limb in the adaptation of transtibial amputee obstacle crossing following rehabilitation
preference. There was a general bias towards adopting the intact limb as the lead limb which reduced over time. Peak knee flexion during swing phase and subsequent loading response (p=0.04) were increased when leading with the intact limb (p=0.03). When leading with the intact limb, peak knee power absorption during late stance (K3) (p=0.05) and during swing (K4) (p=0.01) were significantly higher. The concentric power generation during late stance at the hip (H3) was significantly increased when leading with the intact limb (p=0.05). Peak knee power absorption during loading response (K1) (p=0.04) and peak power generation (K2) (p=0.02) were greater when trailing with the intact limb. Peak power absorption (K4) was greater when trailing with the intact limb when compared to the affected limb (p=0.01). Discussion & conclusions: Transtibial amputees were able to negotiate obstacles effectively and tended to lead with the intact limb. Although the selection of a lead limb preference may be due to the increased ability to ‘push off’ at the end of the preceding stance phase [1], results from the current study suggest that the role of the intact limb having crossed the obstacle is also important. Results indicated that participants may have selected a lead limb preference for two reasons. Firstly, the greater control possible when crossing the obstacle reflected in joint kinematics. Secondly, the ability to maintain relatively high joint moments and generate and absorb power in the stance phase limb during the subsequent stance phase following obstacle crossing. Increasing affected limb hip flexor and knee extensor function may improve an amputee’s ability to cross obstacles when leading with the affected limb. This may also reduce the lead limb bias observed in the current study and increase amputees’ ability to avoid unexpected obstacles and subsequent falls.
Cleveland T. Barnett 1 , Natalie Vanicek 2 , Remco C.J. Polman 3
References
1
[1] Hill SW, et al. Gait Posture 1997;6:186–92. [2] Vrieling AH, et al. Clin Rehabil 2009;23:659–71.
Nottingham Trent University, SHAPE Research Group, School of Science and Technology, Nottingham, UK 2 University of Sydney, Discipline of Exercise and Sport Science, Faculty of Health Sciences, Sydney, Australia 3 Victoria University, Institute of Sport, Exercise and Active Living, Melbourne, Australia Introduction: Obstacle crossing is a complex motor skill necessary to avoid tripping or falling. Understanding how recent lower limb amputees adapt to crossing obstacles could have important implications for amputees and therapists involved in rehabilitation. Previous research has not investigated the re-learning process that occurs following discharge from rehabilitation as amputees adapt to new biomechanical constraints [1,2]. The aim of the current study was to investigate the longitudinal biomechanical adaptations in transtibial amputee obstacle crossing following discharge from rehabilitation. Patients/materials and methods: Seven participants (age 56.1±14.9 years, height 1.82±0.08m, mass 91.7±11.4 kg) attended standardised data collection sessions at one, three and six months following discharge from rehabilitation. Reflective markers were attached to the lower limb according to the six degrees of freedom marker model set. Participants crossed an obstacle (0.1m by 1.0m) whilst walking along an eight-metre walkway at a self selected velocity. Lower limb kinematic (100 Hz) and kinetic (1000 Hz) data were processed and modelled in Visual 3D (C-Motion, Inc, Germantown, US) with variables normalised to the gait cycle. Self selected lead limb preference was noted during each trial. Group mean data were analysed using a linear mixed model (SPSS Inc., Chicago, USA). Results: Participants walking velocity increased by 0.17 m.s-1 between one and six months post-discharge, regardless of lead limb
http://dx.doi.org/10.1016/j.gaitpost.2013.07.056 O43 Gait strategies of transfemoral amputees descending slopes Daniel W.W. Heitzmann, Merkur Alimusaj, Julia Block, Thomas Dreher, Frank Braatz, Sebastian I. Wolf Heidelberg University Clinics, Department of Orthopedics and Trauma Surgery, Heidelberg, Germany Introduction: Current hydraulic and microprocessor controlled prosthetic knee joints for trans-femoral amputees (TFA) enable the user to flex the prosthetic knee throughout weight bearing of the prosthetic limb. TFA are able to use this functionality while alternate walking down stairs or descending inclines [1]. However, clinical practice shows that not all TFA use this so called “stance phase flexion” on slopes, especially on inclines with a moderate angle. This study investigates variations in gait strategy of TFA while walking down slopes. Patients/materials and methods: Five male TFA (48.6y ± 12.9y/99.5 kg ± 20.3 kg/1.77m ± 0.06m) were fitted with a microprocessor controlled prosthetic knee (Rheo Knee IITM ) and a common prosthetic foot (Variflex EVOTM/ all parts Ossur, Reykjavik, Iceland). TFA underwent a conventional clinical gait analysis while walking down slopes of 2.5◦ , 5◦ and 7.5◦ . TFA walked at self selected speed and with their preferred strategy. For reference purpose, eleven healthy subjects (NORM/3 female; 8 male/29.6y ±
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
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4.6y/74.4 kg ± 13.8 kg/180.7 cm ± 7.8 cm) finished the same protocol. Results: Prosthetic knee kinematics show that the five TFA have adopted two different strategies for walking down the slopes of 5◦ and 7.5◦ : 1) to bend the prosthetic knee in stance 2) to keep the prosthetic knee in stance extended. On the shallow 2.5◦ slope none of the TFA tends to bend the prosthetic knee in stance. In general TFA slow down on the steeper slopes.
Figure 1: Gait Speed and prosthetic knee kinematics of TFA descending different slopes Discussion & Conclusions For the shallow 2.5◦ slope none of the TFA uses stance phase flexion of the prosthetic knee. For steep slopes this strategy seems to be favorable, possibly for a better control of gait speed. Noticeably, all TFA slow down when they switch from strategy 2 to 1. However, not all users change their strategy. This might be due to individual preferences. Further, the length of the incline, technical properties of the knee and the alignment of the prosthesis may influence this choice of strategy. Reference [1] Bellmann M, et al. Arch Phys Med Rehabil 2010;91:644–52.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.057
O44 Kinematics of upper limbs in adults: Database and repeatability study for anatomical and functional movements Ayman Assi 1,2,3,4,5 , Mohamad Karam 3 , Abir Massaad 4 , Wafa Skalli 5 , Ismat Ghanem 2,4,6 1
University of Saint-Joseph, Pole Technologie Sante, Beirut, Lebanon 2 University of Saint-Joseph, Faculty of Medicine, Beirut, Liban 3 University of Saint-Joseph, Institute of Physiotherapy, Beirut, Lebanon 4 SESOBEL, Gait Lab, Beirut, Lebanon 5 Arts et Metiers ParisTech, Laboratory of Biomechanics, Paris, France 6 Hotel Dieu de France Hospital, Beirut, Lebanon Introduction: Upper limbs (UL) kinematics have been widely studied in healthy and hemiplegic children during functional movements [1–3]. Few studies in the literature have treated UL kinematics in adults or anatomical movements. The aim of this study is to set a protocol and to create a database for UL kinematics in adults for anatomical and functional movements. The repeatability of the protocol was evaluated. Patients/materials and methods: Thirty asymptomatic adults (12 M, 13 F) with an average age of 29 years (SD=7,6) have formed our database. Markers placement on the upper limbs and trunk was based on the International society of Biomechanics (ISB) protocol [3]. Clusters were fixed on the humerus and forearm. Six cameras Vicon MX3 (200 Hz) were used for data acquisition. Anatomical movements were acquired for left and right upper limbs: shoulder circumduction, shoulder: flex/extension, abduction, int/external rotation, horizontal ab/adduction, and elbow: flex/extension, wrist: pron/supination. A table was used to register functional move-
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
paring injured to non-injured leg for the ACL-injured, or dominant to non-dominant leg for the controls. However, significant differences seem to exist between the two ACL-groups in knee and hip angles both before jump-off (p=0.002, p=0.036, linear mixed model) and after landing (p=0.004, p=0.003, linear mixed model), where ACL-R have larger angles than ACL-PT. Nor were there any differences when comparing angles for the non-injured leg for the ACL-injured and the angles for the legs of the controls. Discussion & Conclusions: Subjects with ACL-injury still show reduced jump capacity in terms of distance in their injured leg about 20 years after injury. In contrast, for the non-injured leg the jump capacity is in parity with that of healthy controls. However, this was not reflected by differences in the kinematic maximum angles of the hip, knee and ankle between injured and non-injured leg for the ACL-groups, which indicates that other parameters than maximal angles taken before jump-off and after landing may be more important to investigate when describing the movement pattern after ACL-injury. Significant differences in knee and hip angles between the two ACL-groups, may indicate different movement pattern depending on treatment approach. Further kinematic analyses are under way to explore the kinematic details of the jump which is needed to quantify the movement patterns after ACLinjury in the long term perspective. http://dx.doi.org/10.1016/j.gaitpost.2013.07.055 O42 The role of the intact limb in the adaptation of transtibial amputee obstacle crossing following rehabilitation
preference. There was a general bias towards adopting the intact limb as the lead limb which reduced over time. Peak knee flexion during swing phase and subsequent loading response (p=0.04) were increased when leading with the intact limb (p=0.03). When leading with the intact limb, peak knee power absorption during late stance (K3) (p=0.05) and during swing (K4) (p=0.01) were significantly higher. The concentric power generation during late stance at the hip (H3) was significantly increased when leading with the intact limb (p=0.05). Peak knee power absorption during loading response (K1) (p=0.04) and peak power generation (K2) (p=0.02) were greater when trailing with the intact limb. Peak power absorption (K4) was greater when trailing with the intact limb when compared to the affected limb (p=0.01). Discussion & conclusions: Transtibial amputees were able to negotiate obstacles effectively and tended to lead with the intact limb. Although the selection of a lead limb preference may be due to the increased ability to ‘push off’ at the end of the preceding stance phase [1], results from the current study suggest that the role of the intact limb having crossed the obstacle is also important. Results indicated that participants may have selected a lead limb preference for two reasons. Firstly, the greater control possible when crossing the obstacle reflected in joint kinematics. Secondly, the ability to maintain relatively high joint moments and generate and absorb power in the stance phase limb during the subsequent stance phase following obstacle crossing. Increasing affected limb hip flexor and knee extensor function may improve an amputee’s ability to cross obstacles when leading with the affected limb. This may also reduce the lead limb bias observed in the current study and increase amputees’ ability to avoid unexpected obstacles and subsequent falls.
Cleveland T. Barnett 1 , Natalie Vanicek 2 , Remco C.J. Polman 3
References
1
[1] Hill SW, et al. Gait Posture 1997;6:186–92. [2] Vrieling AH, et al. Clin Rehabil 2009;23:659–71.
Nottingham Trent University, SHAPE Research Group, School of Science and Technology, Nottingham, UK 2 University of Sydney, Discipline of Exercise and Sport Science, Faculty of Health Sciences, Sydney, Australia 3 Victoria University, Institute of Sport, Exercise and Active Living, Melbourne, Australia Introduction: Obstacle crossing is a complex motor skill necessary to avoid tripping or falling. Understanding how recent lower limb amputees adapt to crossing obstacles could have important implications for amputees and therapists involved in rehabilitation. Previous research has not investigated the re-learning process that occurs following discharge from rehabilitation as amputees adapt to new biomechanical constraints [1,2]. The aim of the current study was to investigate the longitudinal biomechanical adaptations in transtibial amputee obstacle crossing following discharge from rehabilitation. Patients/materials and methods: Seven participants (age 56.1±14.9 years, height 1.82±0.08m, mass 91.7±11.4 kg) attended standardised data collection sessions at one, three and six months following discharge from rehabilitation. Reflective markers were attached to the lower limb according to the six degrees of freedom marker model set. Participants crossed an obstacle (0.1m by 1.0m) whilst walking along an eight-metre walkway at a self selected velocity. Lower limb kinematic (100 Hz) and kinetic (1000 Hz) data were processed and modelled in Visual 3D (C-Motion, Inc, Germantown, US) with variables normalised to the gait cycle. Self selected lead limb preference was noted during each trial. Group mean data were analysed using a linear mixed model (SPSS Inc., Chicago, USA). Results: Participants walking velocity increased by 0.17 m.s-1 between one and six months post-discharge, regardless of lead limb
http://dx.doi.org/10.1016/j.gaitpost.2013.07.056 O43 Gait strategies of transfemoral amputees descending slopes Daniel W.W. Heitzmann, Merkur Alimusaj, Julia Block, Thomas Dreher, Frank Braatz, Sebastian I. Wolf Heidelberg University Clinics, Department of Orthopedics and Trauma Surgery, Heidelberg, Germany Introduction: Current hydraulic and microprocessor controlled prosthetic knee joints for trans-femoral amputees (TFA) enable the user to flex the prosthetic knee throughout weight bearing of the prosthetic limb. TFA are able to use this functionality while alternate walking down stairs or descending inclines [1]. However, clinical practice shows that not all TFA use this so called “stance phase flexion” on slopes, especially on inclines with a moderate angle. This study investigates variations in gait strategy of TFA while walking down slopes. Patients/materials and methods: Five male TFA (48.6y ± 12.9y/99.5 kg ± 20.3 kg/1.77m ± 0.06m) were fitted with a microprocessor controlled prosthetic knee (Rheo Knee IITM ) and a common prosthetic foot (Variflex EVOTM/ all parts Ossur, Reykjavik, Iceland). TFA underwent a conventional clinical gait analysis while walking down slopes of 2.5◦ , 5◦ and 7.5◦ . TFA walked at self selected speed and with their preferred strategy. For reference purpose, eleven healthy subjects (NORM/3 female; 8 male/29.6y ±
ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116
S27
4.6y/74.4 kg ± 13.8 kg/180.7 cm ± 7.8 cm) finished the same protocol. Results: Prosthetic knee kinematics show that the five TFA have adopted two different strategies for walking down the slopes of 5◦ and 7.5◦ : 1) to bend the prosthetic knee in stance 2) to keep the prosthetic knee in stance extended. On the shallow 2.5◦ slope none of the TFA tends to bend the prosthetic knee in stance. In general TFA slow down on the steeper slopes.
Figure 1: Gait Speed and prosthetic knee kinematics of TFA descending different slopes Discussion & Conclusions For the shallow 2.5◦ slope none of the TFA uses stance phase flexion of the prosthetic knee. For steep slopes this strategy seems to be favorable, possibly for a better control of gait speed. Noticeably, all TFA slow down when they switch from strategy 2 to 1. However, not all users change their strategy. This might be due to individual preferences. Further, the length of the incline, technical properties of the knee and the alignment of the prosthesis may influence this choice of strategy. Reference [1] Bellmann M, et al. Arch Phys Med Rehabil 2010;91:644–52.
http://dx.doi.org/10.1016/j.gaitpost.2013.07.057
O44 Kinematics of upper limbs in adults: Database and repeatability study for anatomical and functional movements Ayman Assi 1,2,3,4,5 , Mohamad Karam 3 , Abir Massaad 4 , Wafa Skalli 5 , Ismat Ghanem 2,4,6 1
University of Saint-Joseph, Pole Technologie Sante, Beirut, Lebanon 2 University of Saint-Joseph, Faculty of Medicine, Beirut, Liban 3 University of Saint-Joseph, Institute of Physiotherapy, Beirut, Lebanon 4 SESOBEL, Gait Lab, Beirut, Lebanon 5 Arts et Metiers ParisTech, Laboratory of Biomechanics, Paris, France 6 Hotel Dieu de France Hospital, Beirut, Lebanon Introduction: Upper limbs (UL) kinematics have been widely studied in healthy and hemiplegic children during functional movements [1–3]. Few studies in the literature have treated UL kinematics in adults or anatomical movements. The aim of this study is to set a protocol and to create a database for UL kinematics in adults for anatomical and functional movements. The repeatability of the protocol was evaluated. Patients/materials and methods: Thirty asymptomatic adults (12 M, 13 F) with an average age of 29 years (SD=7,6) have formed our database. Markers placement on the upper limbs and trunk was based on the International society of Biomechanics (ISB) protocol [3]. Clusters were fixed on the humerus and forearm. Six cameras Vicon MX3 (200 Hz) were used for data acquisition. Anatomical movements were acquired for left and right upper limbs: shoulder circumduction, shoulder: flex/extension, abduction, int/external rotation, horizontal ab/adduction, and elbow: flex/extension, wrist: pron/supination. A table was used to register functional move-