Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees

Abstract

Abstract-The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O 2 C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O 2 C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.

Does unilateral transtibial amputation lead to greater metabolic demand during walking?

“…This increased metabolic rate was not observed at controlled or self-selected velocities in this study. To our knowledge, the only other reports of similar rates between individuals with amputation and nondisabled controls were the result of significantly slower walking velocities in the TTA group [15].…”

“…Other influencing factors include walking surface [6,8,[15][16], prosthetic componentry [17][18][19][20][21], prosthesis gait experience [22], residual limb length [1,10], baseline fitness [1,6,23], age [1,6], and comorbidities [9,23]. Gaily et al considered multiple factors of energy expenditure following TTA and found that the baseline rate of oxygen consumption (VO 2 ) contributed to 40 percent of the variance in the data [1].…”

Energy Expenditure of Walking with Prostheses

“…Paysant et al demonstrated that when amputees were exposed to a difficult environment, their walking speed decreased and energy expenditure increased markedly. 8 The treadmill test also included an uphill walking option which is known to have different adjustment characteristics in amputee patients. 9 To our knowledge this is the first study comparing the energy expenditure of partial foot amputees with that of trans-tibial and trans-femoral amputees.…”

Biomechanics and physiological parameters during gait in lower-limb amputees: A systematic review

“…Eight of the studies examined (9%) [17][18][19][20][21][22][23][24] had a combination of biomechanical, physiological and EMG outcomes; 12 (13%) [15,[25][26][27][28][29][30][31][32][33][34][35] had a combination of biomechanical and clinical/ functional outcomes; 2 (2%) [36,37] had a combination of physiological and clinical/functional outcomes; and 17 (19%) [26,28,31,[33][34][35][37][38][39][40][41][42][43][44][45][46][47] had a combination of biomechanical or physiological outcomes with various questionnaires about levels of activity, prosthesis comfort and/or functionality. Table 3 shows the frequency distribution of the 89 articles selected from 23 biomedical journals.…”