INVESTIGATION OF THE EFFECTS OF DIFFERENT PROSTHESIS USAGE PERIODS ON GAIT IN UNILATERAL TRANSFEMORAL AMPUTEES: A CROSS SECTIONAL STUDY

Yıl 2024, Cilt: 9 Sayı: 3, 13 - 21, 31.12.2024

Osman Söyler , Banu Ünver

https://doi.org/10.52881/gsbdergi.1537717

Öz

Prosthesis use in unilateral transfemoral amputees leads to significant changes in gait mechanics. The duration of prosthesis usage is one of the critical factors affecting the walking ability of these individuals. This study aimed to examine the gait parameters of unilateral transfemoral amputees with different periods of prosthesis usage and to evaluate the effects of prosthesis usage on gait. A total of 45 participants aged 18-45 were included in the study, divided into three groups: unilateral transfemoral amputees who recently started using a prosthesis (n=15), transfemoral amputees who have been using a prosthesis for at least three years (n=15), and healthy individuals (n=15). Gait assessment was performed using the UltiumTM Smartlead insole-based plantar pressure analysis. It was found that the stance phase was shorter, swing phase and step duration were longer on the prosthetic side compared to the healthy side in new and experienced amputees (p<0.05), while the stance phase, swing phase and step time were similar on the dominant and non-dominant sides (p>0.05) in the healthy group. It was observed that experienced and new amputees were similar in terms of stance phase difference, swing phase difference, step duration difference and cadence variables (p>0.05) and that the stance phase difference, swing phase difference and step duration difference values of these two groups were higher and cadence values were lower compared to the control group (p<0.05). The double support phase duration of experienced amputees was found to be shorter than that of new amputees (p<0.05). Our study indicated that experienced and new amputees had similar stance phase, swing phase and step duration asymmetries and that these values were higher than healthy individuals, and also that the walking cadence of amputees was lower than healthy individuals. It was revealed that the duration of prosthesis use had no effect in improving walking asymmetry in unilateral transfemoral amputees.

Anahtar Kelimeler

Amputee, prosthesis, transfemoral, gait

UNİLATERAL TRANSFEMORAL AMPUTELERDE FARKLI PROTEZ KULLANIM PERİYOTLARININ YÜRÜYÜŞ ÜZERİNE ETKİSİNİN İNCELENMESİ: KESİTSEL ÇALIŞMA

Öz

Unilateral transfemoral amputelerde protez kullanımı yürüyüş mekaniğinde önemli değişikliklere yol açar. Protez kullanım süresi bu bireylerin yürüme yeteneğini etkileyen kritik faktörler arasındadır. Bu çalışmada, farklı protez kullanım sürelerine sahip unilateral transfemoral amputelerin yürüyüş parametrelerinin incelenmesi ve protez kullanımının yürüyüş üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır. Çalışmaya 18-45 yaş aralığındaki 45 katılımcı üç grupta dahil edilmiştir: yeni protez kullanmaya başlayan unilateral transfemoral amputeler (n=15), en az 3 yıldır protez kullanan transfemoral amputeler (n=15) ve sağlıklı bireyler (n=15). Yürüyüş değerlendirmesi UltiumTM Smartlead tabanlıklı plantar basınç analizi kullanılarak yapılmıştır. Yeni ve deneyimli amputelerde sağlam tarafa göre prostetik taraf duruş fazının daha kısa, sallanma fazı ve adım süresinin daha uzun olduğu (p<0,05), sağlıklı grupta ise dominant ve non-dominat tarafta duruş fazı, sallanma fazı ve adım süresi uzunluklarının benzer olduğu (p>0,05) bulunmuştur. Duruş fazı fark, sallanma fazı fark, adım süresi fark ve kadans değişkenleri açısından deneyimli ve yeni amputelerin benzer olduğu (p>0.05) ve bu iki grubun kontrol grubuna kıyasla duruş fazı fark, sallanma fazı fark ve adım süresi fark değerlerinin daha fazla, kadans değerlerinin ise daha düşük olduğu görülmüştür (p<0,05). Deneyimli amputelerin çift destek fazı süresinin yeni amputelerden daha kısa olduğu görülmüştür (p<0,05). Çalışmamız, deneyimli ve yeni amputelerin benzer duruş fazı, sallanma fazı ve adım süresi asimetrilerine sahip olduğunu ve bu değerlerin sağlıklı bireylerden daha fazla olduğunu, ayrıca, amputelerin yürüyüş kadansının sağlıklı bireylere göre daha düşük olduğunu göstermiştir. Unilateral transfemoral amputelerde protez kullanım süresinin yürüyüş asimetrisini iyileştirme açısından bir etkisi olmadığı çıkarımı yapılmıştır.

Anahtar Kelimeler

Ampute, protez, transfemoral, yürüyüş

Etik Beyan

Lokman Hekim Üniversitesi Bilimsel Araştırmalar Etik Kurulu, 2023/199 numaralı Kod no:2023187'teki çalışmayı onaylanmıştır. Çalışma Helsinki Deklarasyonu'na uygun olarak 23.10.2023 ile 06.08.2024 arasında gerçekleştirilmiştir.

Kaynakça

• Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J. 2002 Aug; 95(8):875-83. doi: 10.1097/00007611-200208000-00018. PMID: 12190225.
• Chang Y, Ko CY, Jeong B, Kang J, Choi HJ, Kim G, ve ark. Changes in spatiotemporal parameters and lower limb coordination during prosthetic gait training in unilateral transfemoral amputees. Int. J. Precis. Eng. Manuf. 2022; 23: 361–373. https://doi.org/10.1007/s12541-021-00605-y
• Davies B, Datta D. Mobility outcome following unilateral lower limb amputation. Prosthet Orthot Int. 2003;27(3):186-190. https://doi.org/10.1080/03093640308726681
• Sagawa Y Jr, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture. 2011;33(4):511-526. https://doi.org/10.1016/j.gaitpost.2011.02.003
• Morgenroth DC, Roland M, Pruziner AL, Czerniecki JM. Transfemoral amputee intact limb loading and compensatory gait mechanics during down slope ambulation and the effect of prosthetic knee mechanisms. Clin Biomech. 2018;55:65-72. https://doi.org/10.1016/j.clinbiomech.2018.04.007
• Raffin E, Mattout J, Reilly KT, Giraux P. Disentangling motor execution from motor imagery with the phantom limb. Brain. 2012 Feb; 135(Pt 2): 582-95. doi: 10.1093/brain/awr337. PMID: 22345089.
• Sedran L, Bonnet X, Thomas-Pohl M, Loiret I, Martinet N, Pillet H, Paysant J. Quantification of push-off and collision work during step-to-step transition in amputees walking at self-selected speed: Effect of amputation level. J Biomech. 2024;163:111943. https://doi.org/10.1016/j.jbiomech.2024.111943
• Ravari R, Rehani M, Hebert JS. Biomechanical characteristics of transfemoral bone-anchored prostheses during gait: A review of literature. Prosthet Orthot Int.2024;48(4):412-421. https://doi.org/10.1097/PXR.0000000000000263
• Timmermans C, Cutti AG, van Donkersgoed H, Roerdink M. Gaitography on lower-limb amputees: Repeatability and between-methods agreement. Prosthet Orthot Int. 2019 Feb;43(1):71-79. doi: 10.1177/0309364618791618. Epub 2018 Aug 13. PMID: 30101682.
• Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191. https://doi.org/10.3758/bf03193146
• Castro MP, Soares D, Mendes E, Machado L. Plantar pressures and ground reaction forces during walking of individuals with unilateral transfemoral amputation. PM R. 2014 Aug;6(8):698-707.e1. doi: 10.1016/j.pmrj.2014.01.019. Epub 2014 Jan 29. PMID: 24487128.
• Park S, You JSH. Effects of homologous instrument-assisted mobilization (HIM) on ankle movement, gait-related muscle activation, and plantar pressure distribution in ankle dorsiflexion syndrome: A randomized single control trial. Technol Health Care.2024;32(S1):511-522. https://doi.org/10.3233/THC-248045
• Barton B. Peat J. Medical statistics: A guide to SPSS, data analysis and critical appraisal, John Wiley & Sons. 2014
• Field, A. Discovering statistics using IBM SPSS statistics (5td ed.). SAGE Publications. 2017
• Segal AD, Orendurff MS, Klute GK, McDowell ML, Pecoraro JA, Shofer J, Czerniecki JM. Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees. J Rehabil Res Dev. 2006;43(7):857-870. https://doi.org/10.1682/jrrd.2005.09.0147
• Carse B, Scott H, Brady L, Colvin J. A characterisation of established unilateral transfemoral amputee gait using 3D kinematics, kinetics and oxygen consumption measures. Gait Posture. 2020;75:98-104. https://doi.org/10.1016/j.gaitpost.2019.09.029
• Kaufman KR, Frittoli S, Frigo CA. Gait asymmetry of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Clin Biomech. 2012;27(5):460-465. https://doi.org/10.1016/j.clinbiomech.2011.11.011
• Highsmith MJ, Schulz BW, Hart-Hughes S, Latlief GA, Phillips SL. Differences in the spatiotemporal parameters of transtibial and transfemoral amputee gait. JPO: Journal of Prosthetics and Orthotics. 2010;22(1):26-30. doi: 10.1097/JPO.0b013e3181cc0e34.
• Kaufman KR, Levine JA, Brey RH, McCrady SK, Padgett DJ, Joyner MJ. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Arch Phys Med Rehabil. 2008;89(7):1380-5. doi: 10.1016/j.apmr.2007.11.053. PMID: 18586142; PMCID: PMC2692755.
• Schaarschmidt M, Lipfert SW, Meier-Gratz C, Scholle HC, Seyfarth A. Functional gait asymmetry of unilateral transfemoral amputees. Hum Mov Sci. 2012;31(4):907-917. https://doi.org/10.1016/j.humov.2011.09.004
• He Y, Hu M, Jor A, Hobara H, Gao F, Kobayashi T. Dynamics of Center of Pressure Trajectory in Gait: Unilateral Transfemoral Amputees Versus Non-Disabled Individuals. IEEE Trans Neural Syst Rehabil Eng. 2024;32:1416-1425. doi:10.1109/TNSRE.2024.3381046. Epub 2024 Apr 1. PMID: 38517721.
• Wentink EC, Prinsen EC, Rietman JS, Veltink PH. Comparison of muscle activity patterns of transfemoral amputees and control subjects during walking. J Neuroeng Rehabil. 2013;10:87. https://doi.org/10.1186/1743-0003-10-87
• Morgan SJ, Hafner BJ, Kelly VE. The effects of a concurrent task on walking in persons with transfemoral amputation compared to persons without limb loss. Prosthet Orthot Int. 2016;40(4):490-496. https://doi.org/10.1177/0309364615596066