Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma (original) (raw)
Related papers
Journal of Orthopaedic Surgery, 2019
Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. Methods: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. Results: There were differences between the three groups in the residual/non-preferred limb (RNp) step length (p ¼ 0.031), the intact/preferred (IP) limb step length variability (p ¼ 0.001), the RNp step length variability (p < 0.001), the time on each foot (p < 0.001), and the ambulation index score (p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths (p ¼ 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss (p ¼ 0.224). Conclusions: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.
Journal of Rehabilitation Research and Development, 2014
Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001), harmony (p < 0.001), and symmetry (p < 0.001) of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.
Physical Disability After Severe Lower-Extremity Injury
Archives of Physical Medicine and Rehabilitation, 2006
Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ, and the LEAP Study Group. Physical disability after severe lower-extremity injury. Arch Phys Med Rehabil 2006; 87:1153-5.
Reorganization of Gait After Limb-Saving Surgery of the Lower Limb
American Journal of Physical Medicine & Rehabilitation, 2003
de Visser E, Veth RPH, Schreuder HWB, Duysens J, Mulder T: Reorganization of gait after limb-saving surgery of the lower limb. Am J Phys Med Rehabil 2003;82:825-831. Objective: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients.
Scandinavian journal of plastic and reconstructive surgery and hand surgery, 2000
Gait patterns of the preferred speed were investigated on 17 patients recovering (9 months-14 years) after reconstruction of severe tibial fractures. A novel data-acquisition system was used to record the plantar pressures as well as electromyographic (EMG) activities during walking. The results indicated incomplete recovery of symmetrical gait patterns. In particular, the duration of the stance phase was shorter on the operated side (mean (SD) 701 (90) ms compared with 765 (128) ms, p`0.001). The peak pressure points under the foot were different on bilateral comparison, the operated side being regularly higher under the lateral forefoot area. This may imply attempts to reduce the loading of the ankle joint during stance. The pressure distribution models reflected these asymmetrical patterns more specifically than the EMG activities of the lower leg muscles examined.
Efficiency of gait measurement after complex foot trauma
Foot and Ankle Surgery, 1996
Four different gait analysis techniques (three-dimensional kinematic analysis, two force plates, dynamic electromyography (EMG), dynamic analysis of plantar pressure distribution) were employed in a study on 10 normal subjects and 12 patients after treatment of displaced calcaneal fractures. The aim was to evaluate each method for accuracy of measurement of the severity of functional impairment. Analysis of ankle joint kinematics revealed that the loss of motion after trauma at the subtalar joint (range of motion after injury 2.9 _+ 2.0 °, normal subjects 7.5 + 2.6 °) was compensated by an increased inward rotation of the foot. If the foot adduction mechanism did not suffice to prevent lateralization of the resultant force, additional inverting or adducting mechanisms (at the ankle, knee, hip and the pelvic level) could be demonstrated. Generally, three-dimensional joint moments and the shank muscle activity pattern were changed at an insignificant level. Force plate data and the analysis of plantar pressure distribution allowed us to assess gait with an accuracy of 83%. For evaluation of dynamic joint motion at the ankle level or above, classical kinetic-kinematic studies are indispensable but, as the kinetics and kinematics at the examined joint levels are highly complex, they can hardly be used to formulate a simple and reliable measure of gait. As the ground reaction force and the plantar impulse distribution as assessed by dynamic pedography represent the net sum of the effects of both the primary gait disturbance and the existing compensation mechanisms, these methods can easily be used for verification and quantification of gait disturbance with an acceptable cost/effectiveness ratio.
Journal of NeuroEngineering and Rehabilitation
Background: The literature suggests that optimal levels of gait symmetry might exist for lower-limb amputees. Not only these optimal values are unknown, but we also don't know typical symmetry ratios or which measures of symmetry are essential. Focusing on the symmetries of stance, step, first peak and impulse of the ground reaction force, the aim of this work was to answer to three methodological and three clinical questions. The methodological questions wanted to establish a minimum set of symmetry indexes to study and if there are limitations in their calculations. The clinical questions wanted to establish if typical levels of temporal and loading symmetry exist, and change with the level of amputation and prosthetic components. Methods: Sixty traumatic, K3-K4 amputees were involved in the study: 12 transfemoral mechanical knee users (TFM), 25 C-leg knee users (TFC), and 23 transtibial amputees (TT). Ninety-two percent used the Ossur Variflex foot. Ten healthy subjects were also included. Ground reaction force from both feet were collected with the Novel Pedar-X. Symmetry indexes were calculated and statistically compared with regression analyses and non-parametric analysis of variance among subjects. Results: Stance symmetry can be reported instead of step, but it cannot substitute impulse and first peak symmetry. The first peak cannot always be detected on all amputees. Statistically significant differences exist for stance symmetry among all groups, for impulse symmetry between TFM and TFC/TT, for first peak symmetry between transfemoral amputees altogether and TT. Regarding impulse symmetry, 25% of TFC and 43% of TT had a higher impulse on the prosthetic side. Regarding first peak symmetry, 59% of TF and 30% of TT loaded more the prosthetic side. Conclusions: Typical levels of symmetry for stance, impulse and first peak change with the level of amputation and componentry. Indications exist that C-leg and energy-storage-and-return feet can improve symmetry. Results are suggestive of two mechanisms related to sound side knee osteoarthritis: increased impulse for TF and increased first peak for TT. These results can be useful in clinics to set rehabilitation targets, understand the advancements of a patient during gait retraining, compare and chose components and possibly rehabilitation programs.
Clinical Biomechanics, 2020
Background: People with lower limb amputation often walk with asymmetrical gait patterns potentially leading to long-term health problems, ultimately affecting their quality of life. The ability to discreetly detect and quantify the movement of bilateral thighs and shanks using wearable sensor technology can provide additional insight into how a person walks with a lower limb prosthesis. This study investigated segmental symmetry and segmental repeatability of people with unilateral lower limb amputation, examining performance of the prosthetic and intact limbs. Methods: Gyroscope signals were recorded from four inertial measurement units worn on bilateral lower limb segments of subjects with unilateral lower limb amputation during the 10-m walk test. Raw angular velocity signals were processed using dynamic time warping and application of algorithms resulting in symmetry measures comparing similarity of prosthetic to intact limb strides, and repeatability measures comparing movement of one limb to its consecutive strides. Findings: Biomechanical differences in performance of the prosthetic and intact limb segments were detected with the segmental symmetry and segmental repeatability measures in 128 subjects. More asymmetries and less consistent movements of the lower limbs were exhibited by subjects with transfemoral amputation versus transtibial amputation (p < .004, Cohen's d = 0.65-1.1). Interpretation: Sensor-based measures of segmental symmetry and segmental repeatability were found to be reliable in detecting discreet differences in movement of the prosthetic versus intact lower limbs in amputee subjects. These measures provide a convenient tool for enhanced prosthetic gait analysis with the potential to focus rehabilitative and prosthetic interventions.
Changes in gait symmetry, gait velocity and self-reported function following total hip replacement
Journal of Rehabilitation Medicine, 2011
To investigate the magnitude of change at different time points in measures of gait symmetry, gait velocity and self-reported function following total hip replacement. Design: Longitudinal with test occasions pre-surgery and 3, 6 and 12 months post-surgery. Subjects: Thirty-four patients with hip osteoarthritis (mean age 63 years, standard deviation 11 years). Methods: Subjects walked back and forth along a 7-m walkway at slow, preferred and fast speed. Anteroposterior, vertical and mediolateral trunk symmetry was assessed by accelerometry, while single support symmetry, step-length symmetry and gait velocity was simultaneously assessed by an electronic walkway. Self-reported function was assessed by Hip disability and Osteoarthritis Outcome Score. Gait symmetry data were normalized for gait velocity. Changes between test occasions were reported as effect size. Results: All measures showed effect sizes > 0.30 from preoperative to 12-months postoperative assessments, and improvements were significant (p < 0.05) in all measures, except medio lateral symmetry. In general, gait symmetry and gait velocity improved most 6 and 12 months postoperatively, while self-reported function improved most 3 months postoperatively. Conclusion: Early improvements were seen in self-reported function, suggesting immediate relief from stiffness and pain, while gait symmetry and velocity improved later postoperatively, suggesting that gait quality and performance require prolonged rehabilitation with postoperative guidance, muscular strengthening and motor relearning.