Gait asymmetry is associated with performance-based physical function among adults with lower-limb amputation

Seth, Mayank; Coyle, Peter C; Pohlig, Ryan T.; Beisheim, Emma Haldane; Horne, John Robert; Hicks, Gregory E.; Sions, Jaclyn Megan

doi:10.1080/09593985.2021.1990449

Cited by 11 publications

(12 citation statements)

References 50 publications

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“…Future studies should explore whether the adoption of a multimodal approach can capture the alterations in performance-based walking measures ( 69 ), the metabolic cost of walking ( 32 , 70 ), self-perceived mobility and balance outcomes ( 37 , 71 ), and the acceptance of prostheses ( 3 ). In the clinical practice, the outcomes of the rehabilitation therapies are often measured by means of qualitative scales, such as the K-Level, which to date is the main scale used by physicians to choose the most adequate prosthetic device.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Marchis

Ranaldi

Varrecchia

et al. 2022

Front. Rehabilit. Sci.

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Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect.

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Section: Discussionmentioning

confidence: 99%

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Marchis

Ranaldi

Varrecchia

et al. 2022

Front. Rehabilit. Sci.

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“…First, we observed that few studies included essential determinants of community ambulation, such as parameters related to prosthetic fit or gait quality (11% and 7% of the included articles, respectively). Research has demonstrated that gait symmetry and step length, i.e., indications of gait quality, are associated with performance-based measures [ 129 ], and that walking capacity is associated with walking performance in the community [ 28 , 61 ]. Hence, gait quality might also be associated with the amount and structure of community ambulation.…”

Section: Discussionmentioning

confidence: 99%

Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review

Mellema

Gjøvaag

2022

Sensors

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Background: The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. Methods: The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. Results and conclusions: 98 articles met the inclusion criteria. According to the included studies’ main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.

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“…Although many people with lower-limb amputation achieve community ambulation, there are few interventions targeting reduced step length asymmetry which may contribute to persistent asymmetries that negatively influence gait efficiency and function. 6,7 The purpose of this study was to evaluate the feasibility and efficacy of a repeated session, treadmill-based EAT protocol on asymmetry of spatiotemporal gait measures in people with nontraumatic TTA. The results partially support our hypotheses, demonstrating high protocol fidelity, high participant acceptability, and a signal of efficacy for the 4-week EAT protocol while noting a specific safety concern related to residual limb integumentary health.…”

Section: Discussionmentioning

confidence: 99%

“…step length and stance time) 4,5 that may adversely influence gait efficiency 6 and functional performance. 7 Despite chronic step length asymmetry following lower-limb amputation, there are few established multisession gait training interventions using biofeedback to reduce step length asymmetry after lower-limb amputation. [8][9][10][11] Error-augmentation gait training (EAT) is a form of biofeedback which exaggerates a known gait deviation to induce motor adaptation of a new movement pattern by the nervous system.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of repeated session error-augmentation gait training for people with nontraumatic transtibial amputation

Kline

Davis-Wilson

et al. 2022

Prosthetics &Amp; Orthotics International

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Background:Spatiotemporal gait asymmetries are a persistent problem for people with non-traumatic lower-limb amputation. To date, there is limited knowledge of multi-session gait training interventions targeting step length symmetry after non-traumatic amputation.Objective:The objective was to evaluate the feasibility and efficacy of an eight-session, treadmill-based error-augmentation gait training (EAT) protocol to improve spatiotemporal gait asymmetry in people with non-traumatic transtibial amputation (TTA).Study Design:Pre-post, single group. Methods: The EAT protocol involved eight training sessions (twice per week, four weeks) of supervised split-belt treadmill walking with asymmetrical belt speeds for five, three-minute sets each session. Step length symmetry during overground walking at a self-selected gait speed was assessed prior to, weekly, and one-week after the EAT protocol. Feasibility outcomes included protocol fidelity, safety, participant acceptability, and efficacy.Results:Seven of the eight participants (87.5%) completed the intervention at the prescribed dose. One participant developed a skin blister on their residual limb, which was possibly related to the intervention. No falls, musculoskeletal injuries, or increases in pain occurred. Participants rated EAT as acceptable based on scores on the Intrinsic Motivation Inventory – Interest/Enjoyment subscale (6.6 ± 0.5; mean ± SD). Average between-limb step length Normalized Symmetry Index improved (was reduced) one-week following EAT (2.41 ± 6.6) compared to baseline (5.47 ± 4.91) indicating a moderate effect size (d=0.53).Conclusions:An eight session EAT program delivered over four weeks using a split-belt treadmill is feasible for people with unilateral non-traumatic TTA and may reduce step length asymmetry up to a week after intervention.

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Gait asymmetry is associated with performance-based physical function among adults with lower-limb amputation

Cited by 11 publications

References 50 publications

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review

Feasibility of repeated session error-augmentation gait training for people with nontraumatic transtibial amputation

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