Energy Expenditure of Transfemoral Amputees Walking on a Horizontal and Tilted Treadmill Simulating Different Outdoor Walking Conditions

Starholm, Inger Marie; Gjøvaag, Terje; Mengshoel, Anne Marit

doi:10.3109/03093640903585016

Cited by 31 publications

(31 citation statements)

References 15 publications

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“…To date, however, few studies have measured VO 2 max in persons with a LLA. Furthermore, these studies used different test protocols [10,15,16]. They reported lower levels of VO 2 max in participants with a LLA compared with controls.…”

Section: Introductionmentioning

confidence: 99%

Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis

et al. 2019

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ObjectiveTo systematically review the literature on the metabolic costs of activities of daily living (ADL) in persons with a lower limb amputation (LLA).Data sourcesA literature search was undertaken in the Pubmed, Embase, CINAHL, CENTRAL, and PsycINFO databases using keywords and synonyms for LLA, metabolic costs, and ADL. The last search was performed on November 29th, 2017.Study selectionStudies were included if they met the following 2 criteria: participants were adults with a (unilateral or bilateral) LLA and metabolic costs were measured while participants performed a physical activity or ADL.Data extraction and synthesisData of 1,912 participants from 61 studies were included in the systematic review and meta-analysis. The studies used different terms to describe metabolic costs. Participants were recruited in different settings, relatively healthy, with few comorbidities. Limited data were available on metabolic costs of other activities than walking with a prosthesis. A linear mixed model analysis was performed based on the means reported, with study as unit of analysis and test results of different groups and measurement conditions as repeated measures within the unit of analysis. Predictors entered in the analysis were e.g. level and reason of amputation, age, weight, and height. During walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Additionally, oxygen consumption was determined by the interaction terms walking speed x amputation level and walking speed squared. Heart rate was determined by the interaction term walking speed squared.ConclusionDuring walking, oxygen consumption (ml O2/kg/min) and heart rate (beats/min) increased with a higher walking speed and a more proximal amputation. Data on metabolic costs of other activities were limited. The poor quality of the studies and the relatively healthy participants limited generalizability of the results of the meta-analysis.

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Section: Introductionmentioning

confidence: 99%

Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis

et al. 2019

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“…Although the causes of falls in transfemoral amputees are often unclear, trips are a major risk as these individuals are unable to adequately recover balance from such perturbations [ 6 ]. Patient training has the potential to improve recovery after a trip [ 7 ], but requires that the person adapt their movements to a limb replacement with limited mechanical capabilities and that does not adequately replace the functionality of the lost limb [ 8 , 9 ]. Instead, modifying the response of the prosthesis might help transfemoral amputees avoid falls with potentially less compensatory movements.…”

Section: Introductionmentioning

confidence: 99%

Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase

Shirota

Simon

Kuiken

2015

J NeuroEngineering Rehabil

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BackgroundRecovering from trips is challenging for transfemoral amputees, and attempts often result in falls. Better understanding of the effects of the sensory-motor deficits brought by amputation and the functional limitations of prosthetic devices could help guide therapy and fall prevention mechanisms in prostheses. However, how transfemoral amputees attempt to recover from trips on the sound and prosthesis sides throughout swing phase is poorly understood.MethodsWe tripped eight able-bodied subjects and eight unilateral transfemoral amputees wearing their prescribed prostheses. The protocol consisted of six repetitions of 6 and 4 points throughout swing phase, respectively. We compared recovery strategies in able-bodied, sound side and prosthesis side limbs. The number of kinematic recovery strategies used, when they were used throughout swing phase, and kinematic characteristics (tripped limb joint angles, bilateral trochanter height and time from foot arrest to foot strike) of each strategy were compared across limb groups. Non-parametric statistical tests with corrections for post-hoc tests were used.ResultsAmputees used the same recovery strategies as able-bodied subjects on both sound and prosthesis sides, although not all subjects used all strategies. Compared to able-bodied subjects, amputees used delayed-lowering strategies less often from 30-60 % of swing phase on the sound side, and from 45-60 % of swing phase on the prosthesis side. Within-strategy kinematic differences occurred across limbs; however, these differences were not consistent across all strategies. Amputee-specific recovery strategies—that are not used by control subjects—occurred following trips on both the sound and prosthesis sides in mid- to late swing.ConclusionsCollectively, these results suggest that sensory input from the distal tripped leg is not necessary to trigger able-bodied trip recovery strategies. In addition, the differences between sound and prosthesis side recoveries indicate that the ability of the support leg might be more critical than that of the tripped leg when determining the response to a trip. The outcomes of this study have implications for prosthesis control, suggesting that providing correct and intuitive real-time selection of typical able-bodied recovery strategies by a prosthetic device when it is the tripped and the support limb could better enable balance recovery and avoid falls.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-015-0067-8) contains supplementary material, which is available to authorized users.

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“…In the present study, a group of healthy adults (CON) with average self-reported fitness were tested on a treadmill with a VO2max walk protocol used by transfemoral amputees 15 and with a VO2max running test ("gold standard" test). The VO2max values of the CON group were similar 'following the walking and the running protocol (~40 mL kg -1 min -1 ), demonstrating that the CON subjects achieved similar individual VO2max by both protocols.…”

Section: Validity Of the Walking Protocolmentioning

confidence: 99%

Assessment of aerobic capacity and walking economy of unilateral transfemoral amputees

Gjøvaag¹,

Starholm²,

Mirtaheri³

et al. 2014

Prosthetics &Amp; Orthotics International

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Background; Studies of the maximal oxygen uptake (VO2max) of transfemoral amputees (TFA) have mostly used protocols that activate a relatively small muscle mass. Consequently, TFA VO2max may be systematically underestimated, and the validity of these test protocols is questionable.Objectives; 1) Investigate validity and reliability of a VO2max walking protocol. 2) Compare the VO2max of a TFA group to a group of matching controls (CON).Study design; 1) Randomized crossover study; walking vs. running VO2max for the CON group, 2) case-control study; TFA vs. CON group VO2max.Methods; Twelve TFA and CON participants performed a walking VO2max test with increasing treadmill inclinations to voluntary exhaustion. The CON group also completed a running ("gold-standard") VO2max test.Results; Mean (SD) CON group VO2max following walking and running was similar, i.e. 2.99 (0.6) and 3.09 (0.7) L·min -1 , respectively. Mean (SD) TFA walking VO2max was 2.14 (0.8) L·min -1 (compared to CON; p < 0.01). Mean intra-class correlation coefficient (ICC) of repeated VO2 measurements was 0.97, and within-subjects standard deviation (Sw) was 60 mL min -1 . Conclusions;The walk protocol is valid. Walking VO2max of TFA was 40 % lower compared to CON.Reliability of the walking protocol is comparable to other walking protocols. Word count: 200 Clinical relevanceThe design, alignment and materials of prostheses are important for effective ambulation. Cardiorespiratory fitness is, however, also important in this regard, and a low fitness may compromise health and independent living. Hence, TFA with low physical fitness should engage in regular physical activity to improve health, gait capacity and independency.Word count: 50

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Energy Expenditure of Transfemoral Amputees Walking on a Horizontal and Tilted Treadmill Simulating Different Outdoor Walking Conditions

Cited by 31 publications

References 15 publications

Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis

Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis

Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase

Assessment of aerobic capacity and walking economy of unilateral transfemoral amputees

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