Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss

Keklicek, Hilal; Kirdi, Elif; Yalcin, Ali; Topuz, Semra; Ülger, Özlem; Erbahçeci, Fatih; Şener, Gül

doi:10.1177/2309499019832665

Cited by 17 publications

(21 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of significant differences between AMP and CON groups for kinematic measures of gait stability has also been reported in previous literature. Keklicek et al found that differences in gait variability was more pronounced in individuals with transfemoral amputation, while individuals with transtibial amputation demonstrated gait patterns similar to those in able-bodied subjects [33]. Similarly, our findings across individuals in the AMP group corroborate the findings of Parker et al, which reported no differences in gait variability between individuals with dysvascular or non-dysvascular amputation [34].…”

Section: Discussionsupporting

confidence: 89%

Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Petersen

Sparto

Fisher

2022

Preprint

View full text Add to dashboard Cite

BackgroundIn addition to a range of functional impairments seen in individuals with a lower-limb amputation, this population is at a substantially elevated risk of falls [1,2]. Studies postulate that the lack of sensory feedback from the prosthetic limb contributes heavily to these impairments, but the extent to which sensation affects functional measures remains unclear [3,4].Research QuestionThe purpose of this study is to determine how sensory impairments in the lower extremities relate to performance with common clinical functional measures of balance and gait in individuals with a lower-limb amputation. Here we evaluate the effects of somatosensory integrity to both clinical and lab measures of static, reactive and dynamic balance, and gait stability.MethodsIn 20 individuals with lower-limb amputation (AMP) and 20 age and gender-matched able-bodied controls (CON), we evaluated the relationship of measures of sensation (pressure, proprioception, and vibration) to measures of balance and gait. Static, reactive, and dynamic balance were assessed using the Sensory Organization Test (SOT), Motor Control Test (MCT), and Functional Gait Assessment (FGA), respectively. Gait stability was assessed through measures of step length asymmetry and step width variability. Sensation was categorized into intact or impaired sensation by pressure thresholds and differences across groups were analyzed.ResultsThere were significant differences between AMP and CON groups for the reliance on vision for static balance in the SOT, MCT, and FGA (p<0.01). Despite these differences across groups, there were no significant differences within the AMP group based on intact or impaired sensation across all functional measures.SignificanceDespite being able to detect differences between able-bodied individuals and individuals with an amputation, these functional measures are unable to distinguish between levels of impairment within participants with an amputation. These findings suggest that more challenging and robust metrics are needed to evaluate the relationship of sensation and function in individuals with an amputation.Research reported in this publication was supported by the National Institutes of Health [NINDS Award Number UH3NS100541 and NICHD Award Number F30HD098794]. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health.

show abstract

Section: Discussionsupporting

confidence: 89%

Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Petersen

Sparto

Fisher

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Indeed, using three sensors (MIMUs mounted on the trunk and shanks), the method proposed in the present study achieved similar to improved accuracy (mean NRMSE) and better precision (standard deviation of the NRMSE) compared to the method proposed by Shahabpoor and coworkers using the acceleration of three different segments (trunk, pelvis and a thigh) in healthy participants (present study vs. healthy participants: 11.6 ± 2.1% vs. 16 ± 2.0% in the anteroposterior direction, 21.5 ± 2.7% vs. 18 ± 6.7% in the mediolateral direction and 7.7 ± 0.4% vs. 7 ± 1.7% in the vertical direction). Although walking variability for people with lower-limb amputation is higher with respect to typical gait [ 55 ], it may be speculated that the increased precision in the present study could be related to the fact that only intra-subject variability was considered since a single participant was tested. Conversely, six asymptomatic subjects ambulating at different walking speeds were recruited in [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Estimation of 3D Body Center of Mass Acceleration and Instantaneous Velocity from a Wearable Inertial Sensor Network in Transfemoral Amputee Gait: A Case Study

Simonetti

Bergamini

Vannozzi

et al. 2021

Sensors

View full text Add to dashboard Cite

The analysis of the body center of mass (BCoM) 3D kinematics provides insights on crucial aspects of locomotion, especially in populations with gait impairment such as people with amputation. In this paper, a wearable framework based on the use of different magneto-inertial measurement unit (MIMU) networks is proposed to obtain both BCoM acceleration and velocity. The proposed framework was validated as a proof of concept in one transfemoral amputee against data from force plates (acceleration) and an optoelectronic system (acceleration and velocity). The impact in terms of estimation accuracy when using a sensor network rather than a single MIMU at trunk level was also investigated. The estimated velocity and acceleration reached a strong agreement (ρ > 0.89) and good accuracy compared to reference data (normalized root mean square error (NRMSE) < 13.7%) in the anteroposterior and vertical directions when using three MIMUs on the trunk and both shanks and in all three directions when adding MIMUs on both thighs (ρ > 0.89, NRMSE ≤ 14.0% in the mediolateral direction). Conversely, only the vertical component of the BCoM kinematics was accurately captured when considering a single MIMU. These results suggest that inertial sensor networks may represent a valid alternative to laboratory-based instruments for 3D BCoM kinematics quantification in lower-limb amputees.

show abstract

“…Stance times tended to be shorter on the prosthetic limb compared with the intact limb, with more symmetry in individuals who used transtibial prostheses than transfemoral prostheses. Three studies in this review compared stance time symmetries and found the greatest symmetry in individuals without limb loss, followed by individuals who used transtibial prostheses (89.7%–93.4%), and then individuals who used transfemoral prostheses (58.6%–74.5%) 16,34,35,48 . However, individuals without limb loss and individuals who used transtibial prostheses tended to have similar amounts of symmetry in studies included in this review.…”

Section: Discussionmentioning

confidence: 86%

“…Three studies in this review compared stance time symmetries and found the greatest symmetry in individuals without limb loss, followed by individuals who used transtibial prostheses (89.7%-93.4%), and then individuals who used transfemoral prostheses (58.6%-74.5%). 16,34,35,48 However, individuals without limb loss and individuals who used transtibial prostheses tended to have similar amounts of symmetry in studies included in this review. Individuals who used transfemoral prostheses tended to have the widest range of symmetry across studies with the lowest minimum values.…”

Section: Spatiotemporal Parametersmentioning

confidence: 96%

Normalized Kinematic Walking Symmetry Data for Individuals Who Use Lower-Limb Prostheses: Considerations for Clinical Practice and Future Research

2023

View full text Add to dashboard Cite

Introduction: Individuals who use unilateral transtibial or transfemoral prostheses have negative secondary health effects associated with decreased kinematic (e.g., spatiotemporal and joint angle) walking symmetry between prosthetic and intact limbs. Research studies have quantified kinematic walking symmetry, but studies can be difficult to compare owing to the inclusion of small sample sizes and differences in participant demographics, biomechanical parameters, and mathematical analysis of symmetry. This review aims to normalize kinematic walking symmetry research data across studies by level of limb loss and prosthetic factors to inform considerations in clinical practice and future research. Methods: A search was performed on March 18, 2020, in PubMed, Scopus, and Google Scholar to encompass kinematic walking symmetry literature from the year 2000. First, the most common participant demographics, kinematic parameters, and mathematical analysis of symmetry were identified across studies. Then, the most common mathematical analysis of symmetry was used to recalculate symmetry data across studies for the five most common kinematic parameters. Results: Forty-four studies were included in this review. The most common participant demographics were younger adults with traumatic etiology who used componentry intended for higher activity levels. The most common kinematic parameters were step length, stance time, and sagittal plane ankle, knee, and hip range of motion. The most common mathematical analysis was a particular symmetry index equation. Conclusions: Normalization of data showed that symmetry tended to decrease as level of limb loss became more proximal and to increase with prosthetic componentry intended for higher activity levels. However, most studies included 10 or fewer individuals who were active younger adults with traumatic etiologies. Clinical Relevance: Data summarized in this review could be used as reference values for rehabilitation and payer justification. Specifically, these data can help guide expectations for magnitudes of walking symmetry throughout rehabilitation or to justify advanced prosthetic componentry for active younger adults under 65 years of age with traumatic etiologies to payers.

show abstract

Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss

Cited by 17 publications

References 26 publications

Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Estimation of 3D Body Center of Mass Acceleration and Instantaneous Velocity from a Wearable Inertial Sensor Network in Transfemoral Amputee Gait: A Case Study

Normalized Kinematic Walking Symmetry Data for Individuals Who Use Lower-Limb Prostheses: Considerations for Clinical Practice and Future Research

Contact Info

Product

Resources

About