Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

IJmker, Trienke; Noten, Suzie; Lamoth, Claudine J. C.; Beek, Peter J.; Woude, van der Lucas; Houdijk, Han

doi:10.1016/j.gaitpost.2014.07.013

Cited by 31 publications

(38 citation statements)

References 30 publications

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“…Consistent with previous studies [10, 11, 13, 4], our results confirmed that external lateral stabilization provided medio-lateral gait stability, represented by a direct reduction of medio-lateral pelvis displacement which was accompanied by an indirect reduction of step width in stabilized condition. Consistent with Matsubara et al [22], our results confirmed that external lateral stabilization did not constrain the amplitude of anterior-posterior pelvis displacement because bilateral springs were connected to the horizontal trolley which were capable to move freely and in-phase with the displacement of the center of mass in anterior-posterior direction.…”

Section: Discussionsupporting

confidence: 92%

“…Different stabilizing strategies such as ankle [3], foot placement [2, 4-6], hip [7, 8], and push-off [8] strategies are used to control gait stability. To better understand the control of gait stability, external lateral stabilization devices have been used to manipulate medio-lateral stability [9-13, 4, 14]. It has been reported that external lateral stabilization reduces medio-lateral center of mass displacement [10] leading to lower need to control medio-lateral stability through the medio-lateral foot placement [10, 11, 4].…”

Section: Introductionmentioning

confidence: 99%

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How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

Mahaki

IJmker

Houdijk

et al. 2020

Preprint

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Background:The effect of external lateral stabilization on medio-lateral gait stability has been investigated previously. However, existing lateral stabilization devices not only constrains lateral motions, but also transverse and frontal pelvis rotations. This study aimed to investigate the effect of external lateral stabilization with and without constrained transverse pelvis rotation on mechanical and metabolic gait features. Methods:We undertook 2 experiments with eleven and ten young adult subjects, respectively. Experiment 2 supplemented experiment 1, as it considered several potential confounding factors in the design and set-up of experiment 1. Kinematic, kinetic, and breath-by-breath oxygen consumption data were recorded during 3 walking conditions (normal walking (Normal), lateral stabilization with (Free) and without transverse pelvis rotation (Restricted)) and at 3 speeds (0.83, 1.25, and 1.66 m/s) for each condition.Results: External lateral stabilization significantly reduced the amplitudes of the transverse and frontal pelvis rotations, medio-lateral pelvis displacement, transverse thorax rotation, arm swing, and step width.The amplitudes of free vertical moment, anterior-posterior and vertical pelvis displacements, step length, and energy cost were not significantly influenced by external lateral stabilization. The removal of transverse pelvis rotation restriction by our experimental set-up resulted in significantly higher transverse pelvis rotation, although it remained significantly less than Normal condition. In concert, concomitant gait features such as transverse thorax rotation and arm swing were not significantly influenced by our new set-up. Conclusion:Existing lateral stabilization set-ups not only constrain medio-lateral motions (i.e. mediolateral pelvis displacement), but also constrains other movements such as transverse and frontal pelvis rotations, which leads to several other gait changes such as reduced transverse thorax rotation, and arm swing. Our new setup allowed for more transverse pelvis rotation, however, this did not result in more normal pelvis rotation, arm swing, etc. Hence, to provide medio-lateral support without constraining other gait variables, more elaborate set-ups are needed. Unless such a set-up is realized the observed side effects need to be taken into account when interpreting the effects of lateral stabilization as reported in previous studies.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

Mahaki

IJmker

Houdijk

et al. 2020

Preprint

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“…Curtze has also implemented clinically-accessible methods to test postural control through setups that subject prosthesis users to environments simulating waist-level perturbations (push/pulls) 137 , forward falls 138 , and walking over uneven terrain 139 . In order to prompt responses in frontal plane postural control, prosthesis users have been subjected to medial-lateral perturbations at the waist 140, 141 and foot 142 . Finally, virtual environments that provide visual and surface perturbations have been used to test locomotor stability 143, 144 .…”

Section: Motor Performance As a Patient-specific Variable For Desimentioning

confidence: 99%

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

Major

Fey

2017

Physical Therapy Reviews

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Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.

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“…As such, it is important to recognize the potential limitations of using external lateral stabilization to quantify lateral stabilization costs in impaired populations. For example, this methodology was ineffective for determining the metabolic energy costs of lateral stabilization for transfemoral amputees because the setup impeded compensatory mechanisms [26]. In addition, reduced metabolic cost with external lateral stabilization in individuals with iSCI may have been due to factors other than reducing the mechanical work performed to redirect lateral COM motion each step [8] or to control step width variability [10].…”

Section: Discussionmentioning

confidence: 99%

Metabolic cost of lateral stabilization during walking in people with incomplete spinal cord injury

Matsubara

Gordon

2015

Gait & Posture

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People with incomplete spinal cord injury (iSCI) expend considerable energy to walk, which can lead to rapid fatigue and limit community ambulation. Selecting locomotor patterns that enhance lateral stability may contribute to this population’s elevated cost of transport. The goal of the current study was to quantify the metabolic energy demands of maintaining lateral stability during gait in people with iSCI. To quantify this metabolic cost, we observed ten individuals with iSCI walking with and without external lateral stabilization. We hypothesized that with external lateral stabilization, people with iSCI would adapt their gait by decreasing step width, which would correspond with a substantial decrease in cost of transport. Our findings support this hypothesis. Subjects significantly (p < 0.05) decreased step width by 22%, step width variability by 18%, and minimum lateral margin of stability by 25% when they walked with external lateral stabilization compared to unassisted walking. Metabolic cost of transport also decreased significantly (p < 0.05) by 10% with external lateral stabilization. These findings suggest that this population is capable of adapting their gait to meet changing demands placed on balance. The percent reduction in cost of transport when walking with external lateral stabilization was strongly correlated with functional impairment level as assessed by subjects’ scores on the Berg Balance Scale (R = 0.778) and Lower Extremity Motor Score (R = 0.728). These relationships suggest that as functional balance and strength decrease, the amount of metabolic energy used to maintain lateral stability during gait will increase.

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Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?

Cited by 31 publications

References 30 publications

How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

Metabolic cost of lateral stabilization during walking in people with incomplete spinal cord injury

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