Stepping Asymmetry Among Individuals With Unilateral Transtibial Limb Loss Might Be Functional in Terms of Gait Stability

Hak, Laura; Dieën, Jaap H. van; Wurff, Peter van der; Houdijk, Han

doi:10.2522/ptj.20130431

Cited by 52 publications

(50 citation statements)

References 31 publications

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“…However, increasing gait symmetry for TTA does not necessarily result in an improvement of gait [4]. Moreover, asymmetry may even be a prerequisite to achieve gait stability during ambulation [1]. Reported studies question if current prosthetic alignment approaches are the correct method to optimize prosthetic alignment, since the current approaches are based on achieving symmetry in spatiotemporal and kinematic gait data [35,36].…”

Section: Discussionmentioning

confidence: 99%

“…To compensate for the functional loss, the human body adapts so that it can perform the necessary functions despite the structural asymmetry between the prosthetic limb (PL) and the non-prosthetic limb (NPL) [1]. …”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the swing time and step length of the PL are found to be greater, and the stance phase duration on the NPL are increased, compared to the PL [9,10]. Asymmetry may be a prerequisite to achieve gait stability during ambulation [1]. Therefore, it may be argued that kinematic and spatiotemporal symmetry should not be the goal of dynamic alignment of the prosthesis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Alignment Changes on Unilateral Transtibial Amputee’s Gait: A Systematic Review

et al. 2016

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IntroductionProsthetic alignment, positioning of a prosthetic foot relative to a socket, is an iterative process in which an amputee’s gait is optimized through repetitive optical gait observation and induction of alignment adjustments when deviations are detected in spatiotemporal and kinematic gait parameters. An important limitation of the current prosthetic alignment approach is the subjectivity and the lack of standardized quantifiable baseline values. The purpose of this systematic review is to investigate if an optimal alignment criterion can be derived from published articles. Moreover, we investigated the effect of alignment changes on spatiotemporal, kinematic and kinetic gait parameters.ResultsA total of 11 studies were included, two controlled before-and-after studies and nine-interrupted time series studies.DiscussionThe results demonstrate that alignment changes have a predictable influence on the included kinetic parameters. However, the effect of alignment changes on spatio-temporal and kinematic gait parameters are generally unpredictable. These findings suggest that it is imperative to include kinetics in the process of dynamic prosthetic alignment. Partially this can be established by communication with the prosthetic user in terms of perceived socket comfort, but the use of measurement tools should also be considered. While current literature is not conclusive about an optimal alignment, future alignment research should focus on alignment optimisation based on kinetic outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Alignment Changes on Unilateral Transtibial Amputee’s Gait: A Systematic Review

et al. 2016

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“…Step length data collected during the last 30 seconds determined belt assignments for the split walking condition. A common characteristic of persons with TTA is step length asymmetry and during testing the leg taking a shorter step length was assigned to the fast belt during split-belt walking[20, 21]. This belt assignment strategy was selected because improved step length symmetry is a short-term aftereffect of split-belt walking in those who exhibit baseline asymmetries[14].…”

Section: Methodsmentioning

confidence: 99%

Locomotor adaptability in persons with unilateral transtibial amputation

et al. 2017

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BackgroundLocomotor adaptation enables walkers to modify strategies when faced with challenging walking conditions. While a variety of neurological injuries can impair locomotor adaptability, the effect of a lower extremity amputation on adaptability is poorly understood.ObjectiveDetermine if locomotor adaptability is impaired in persons with unilateral transtibial amputation (TTA).MethodsThe locomotor adaptability of 10 persons with a TTA and 8 persons without an amputation was tested while walking on a split-belt treadmill with the parallel belts running at the same (tied) or different (split) speeds. In the split condition, participants walked for 15 minutes with the respective belts moving at 0.5 m/s and 1.5 m/s. Temporal spatial symmetry measures were used to evaluate reactive accommodations to the perturbation, and the adaptive/de-adaptive response.ResultsPersons with TTA and the reference group of persons without amputation both demonstrated highly symmetric walking at baseline. During the split adaptation and tied post-adaptation walking both groups responded with the expected reactive accommodations. Likewise, adaptive and de-adaptive responses were observed. The magnitude and rate of change in the adaptive and de-adaptive responses were similar for persons with TTA and those without an amputation. Furthermore, adaptability was no different based on belt assignment for the prosthetic limb during split adaptation walking.ConclusionsReactive changes and locomotor adaptation in response to a challenging and novel walking condition were similar in persons with TTA to those without an amputation. Results suggest persons with TTA have the capacity to modify locomotor strategies to meet the demands of most walking conditions despite challenges imposed by an amputation and use of a prosthetic limb.

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“…Preliminary evidence has shown that gait parameters, including step length and stance time, can demonstrate increased between-limb symmetry with specified step training in patients following unilateral TTA [11]. However, the ideal amount of between-limb spatiotemporal symmetry is not known; the loss of a joint (or joints) with amputation creates some level of chronic asymmetry [12]. Although debate exists about the optimum rehabilitation goals, it is widely accepted that an excessive level of gait pattern change is associated with the development of dysfunction [13].…”

Section: Introductionmentioning

confidence: 99%

Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation

et al. 2016

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Little evidence exists to support the presence of differences in spatiotemporal gait parameters and ambulation ability between those individuals with traumatic and nontraumatic lower-limb amputation (LLA). We conducted an exploratory study of 81 male Veterans with unilateral amputation to quantify differences in spatiotemporal gait parameters and ambulatory mobility between Veterans with traumatic and nontraumatic LLA. Furthermore, we identified variables that significantly contributed to the explanation of variability in modified 2-min walk test distance. All participants completed the modified 2-min walk test and a spatiotemporal gait analysis using an instrumented walkway during a routine physical therapy visit. Veterans with nontraumatic LLA walked significantly shorter mean distances during a modified 2-min walk test than Veterans with traumatic LLA. Variables identified as significant contributors to modified 2-min walk test variability were amputated limb stance time, amputated limb step length, and percentage of the gait cycle spent in double support. These findings demonstrate that differences in spatiotemporal gait parameters and ambulatory mobility exist between Veterans with traumatic and nontraumatic LLA and identify important spatiotemporal parameters of gait contributing to this decline. These parameters should be considered as targets for intervention and future investigation.

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Stepping Asymmetry Among Individuals With Unilateral Transtibial Limb Loss Might Be Functional in Terms of Gait Stability

Cited by 52 publications

References 31 publications

The Effect of Alignment Changes on Unilateral Transtibial Amputee’s Gait: A Systematic Review

The Effect of Alignment Changes on Unilateral Transtibial Amputee’s Gait: A Systematic Review

Locomotor adaptability in persons with unilateral transtibial amputation

Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation

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