Relationship between Asymmetry of Gait and Muscle Torque in Patients after Unilateral Transfemoral Amputation

Rutkowska-Kucharska, Alicja; Kowal, Mateusz; Winiarski, Sławomir

doi:10.1155/2018/5190816

Cited by 30 publications

(38 citation statements)

References 33 publications

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“…There are many indices in functional diagnostics used to assess the degree of asymmetry; these have been used by many researchers and are as follows: symmetry index [2, 10, 11], relative difference index [12], relative asymmetry index [13], symmetry ratio [14], asymmetry ratio [15], integral index symmetry [16], symmetry angle [17], or the standard deviation of the differential index for upper limbs [18]. One of them, the symmetry index (SI), proved to be the most reliable tool for the assessment of side deviations in human movements and is widely used in movement analysis [19–21]. Unfortunately, the formula proposed originally by Robinson et al [10] has some limitations, namely, SI being a single number, differences being compared against average values, and being ineffective overall for variables of small values.…”

Section: Introductionmentioning

confidence: 99%

A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement

Winiarski

Rutkowska-Kucharska

Pozowski

et al. 2019

Applied Bionics and Biomechanics

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Purpose We propose a new concept of symmetry, the symmetry function, as a continuous function of the percentage of differences between sides of body movement and normalised throughout the whole range of motion. The method is used to assess the dynamical symmetry of gait of patients after unilateral total hip replacement (asymmetric group) and healthy people (symmetric group) and also to reveal discrepancies between normal and abnormal movement patterns. Methods The gait of twelve male patients (49.7 ± 2.8 y), six weeks after unilateral total hip replacement (uTHR), was analysed against the gait of thirteen healthy men (36.1 ± 3.1 y). The speed of healthy men was matched to the speed of the patients. Comparison of the affected limb in uTHR patients with the healthy limb of able-bodied men was carried out on the basis of the highest symmetry values in the sagittal plane. Results In uTHR patients, the symmetry function provides information on the symmetry of movements in the whole range of motion in contrast to symmetry indices which are calculated for selected parameters or peak values. Research revealed average asymmetric discrepancies for pelvic tilt up to 250% for the entire gait cycle with a peak of approx. 400% at the end of the loading response and terminal swing phases. Asymmetry of gait observed in other joints was below 200% of the mean range of motion. Conclusions Regions of the greatest asymmetry in pathological movements are usually different from the region of the greatest range of motion. Therefore, it is insufficient to measure symmetry only for selected regions during motion. The symmetry function is a simple method which can complement other robust methods in time series data evaluation and interpretation.

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Section: Introductionmentioning

confidence: 99%

A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement

Winiarski

Rutkowska-Kucharska

Pozowski

et al. 2019

Applied Bionics and Biomechanics

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“…The maximum value of the vertical ground reaction force (GRF) component assessed throughout the entire gait cycle was usually the highest in the supporting phase of the TFA gait pattern, and its value for the amputated limb was signi cantly lower than that for the uninvolved limb [29,43,44]. Our previous research showed that variables describing GRF behavior were statistically smaller for the amputated limb regarding values for healthy controls by almost 7.7 percent of body weight (%BW) in the supporting phase, 12.3 %BW in terminal stance, and 12.0 %BW for the posterior braking force at initial stance [25]. Values of the vertical component of GRF during underweight in middle stance were on average 5.8 %BW higher for the amputated limb.…”

Section: Discussionmentioning

confidence: 98%

“…Moreover, prolonged time asymmetric loading of the lower limb may result in atrophy of stump muscles and degenerative changes in the joints [25]. The main challenge is to choose the adequate calculation of asymmetry depending on what aspect of gait one wants to assess.…”

Section: Discussionmentioning

confidence: 99%

“…However, a patient needs to undergo evaluation of their muscle strength and have the therapy program adjusted to their level of muscle strength deficit. Studies of patients after TFA actively participating in various Paralympic sports show that there is a statistically signi cant relationship between gait asymmetry and the strength of the hip extensors muscles [25].…”

Section: Introductionmentioning

confidence: 99%

“…In many publications, gait assessment of patients after TFA is based on a comparison of the components of the ground reaction forces: vertical, anteroposterior and lateral [25][26][27][28][29][30]. Scienti c research shows that especially the asymmetry of the vertical component of the ground reaction force between the limbs can, as a result of long-term asymmetry, lead to degenerative changes within all joints of the healthy lower limb.…”

Section: Introductionmentioning

confidence: 99%

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Symmetry function as a new tool for evaluating the symmetry of gait in transfemoral amputees

Winiarski

Rutkowska-Kucharska

Kowal

2020

Preprint

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Background: Numerous studies have demonstrated significant asymmetries in unilateral amputee gait. The underlying dissimilarities between prosthetic and intact limbs have not yet been widely examined. To gain more insight into the functionality of asymmetries, we propose a new tool, the symmetry function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables of patients after unilateral transfemoral amputation and to identify areas with the largest side deviations in the movement cycle. Methods: An instrumented motion analysis system was used to register the gait of fourteen patients after unilateral trans-femoral amputation (TFA). Measurements involved evaluating the time series of gait variables characterizing a range of motion and the time series of the ground reaction force components. Comparison of the involved limb with the uninvolved limb in TFA patients was carried out on the basis of the SF values.Results: The symmetry function proved to be an excellent tool to localize the regions of asymmetry and their positive or negative directions in the full gait cycle. The difference between sides revealed by the symmetry function was the highest for the pelvis and the hip. In the sagittal plane, the pelvis was asymmetrically tilted, reaching the highest SF value of more than 25% at 60% cycle time. In the transverse plane, the pelvis was even more asymmetrically positioned throughout the entire gait cycle (50% difference on average). The hip in the frontal plane reached a 60% difference in SF throughout the single support phase for the prosthetic and then for the intact limb. Conclusions: The symmetry function allows for the detection of gait asymmetries and shifts in the center of gravity and may assess the precise in time adaptation of prostheses and rehabilitation monitoring, especially in unilateral impairments.Trial registration: The trial registration number (TRN): 379991 issued by the Australian New Zealand Clinical Trials Registry (ANZCTR) on 07.05.2020 (retrospectively registered).

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The relationship of hip strength to walking and balance performance in unilateral lower limb prosthesis users differs by amputation level

Sawers,

Fatone

2024

PM&R

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BackgroundSafe and efficient locomotion is a frequently stated goal of lower limb prosthesis users, for which hip strength may play a central yet poorly understood role. Additional research to identify associations between hip strength, balance, and mobility among transtibial and transfemoral prosthesis users is required.ObjectiveTo test whether residual and/or intact limb isometric hip strength was associated with lower limb prosthesis users’ walking speed, endurance, and balance.DesignCross‐sectional study.SettingResearch laboratory.ParticipantsConvivence sample of 14 transtibial and 14 transfemoral prosthesis users.MethodsMultiple linear regression was used to evaluate the relationship between isometric measures of residual and intact limb hip strength and walking and balance performance.Main Outcome MeasurementsMeasures of isometric hip muscle strength, including peak torque, average torque, torque impulse, and torque steadiness (i.e. consistency with which an isometric torque can be sustained) were derived from maximum voluntary hip flexion, extension, abduction and adduction torque signals collected with a motor‐driven dynamometer. Walking speed, endurance, and balance were assessed by administering the 10‐meter walk test, 2‐minute walk test, Four Square Step Test, and Narrowing Beam Walking Test, respectively.ResultsResidual limb hip extensor max torque and abductor torque steadiness explained between 51% and 69% of the variance in transtibial prosthesis users’ walking speed, endurance, and balance. In contrast, intact limb hip abductor torque impulse explained between 33% and 48% of the variance in transfemoral prosthesis users’ walking speed, endurance, and balance.ConclusionsOur results suggest that unilateral transtibial and transfemoral prosthesis users’ walking and balance performance may depend on different hip muscles, and different facets of hip strength. Amputation level‐specific hip strength interventions may therefore be required to improve walking and balance performance in unilateral transtibial and transfemoral prosthesis users. The “intact leg strategy” adopted by transfemoral prosthesis users may be due to a variety of prosthesis and biomechanical factors that limit the efficiency with which transfemoral prosthesis users can exploit the strength of their residual limb hip muscles while walking.

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Relationship between Asymmetry of Gait and Muscle Torque in Patients after Unilateral Transfemoral Amputation

Cited by 30 publications

References 33 publications

A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement

A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement

Symmetry function as a new tool for evaluating the symmetry of gait in transfemoral amputees

The relationship of hip strength to walking and balance performance in unilateral lower limb prosthesis users differs by amputation level

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