Dataset Information

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

ABSTRACT: Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.

SUBMITTER: Ichimura D

PROVIDER: S-EPMC9778493 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

Ichimura Daisuke D Amma Ryo R Hisano Genki G Murata Hiroto H Hobara Hiroaki H

PloS one 20221222 12

Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We e ...[more]

PMID: 36548294

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Project description:IntroductionA unilateral transfemoral amputation (TFA) has a major impact on function. A leg-length discrepancy is the primary structural change, accompanied by the loss of lower-limb muscle volume and function. Prostheses can help individuals with a TFA to regain function, but such individuals still do not reach the functional level of unimpaired peers and exhibit gait deviations. This study gives insight into the causality between residual limb strength and gait deviations in individuals with a TFA.MethodsA convenient sample of 13 male individuals with a TFA (38.0 ± 12.6y; 179.7cm ± 6.5cm; 82.9kg ± 12.4kg) was recruited for this study. One participant with TFA was excluded, as he differed from the rest of the cohort, in residual limb length and the use of walking aids. A cohort of 18 unimpaired subjects served as a reference group (REF; nine females; 44y ± 13y; 174cm ± 9cm; 71kg ± 12kg). All participants underwent a conventional clinical gait analysis using a marker based 3D motion capture system and force platforms. Kinematics and kinetics were determined utilizing standard modelling methods. All subjects underwent a strength test, using a custom-made device to determine isometric moments of the hip joint in abduction, adduction, extension, and flexion. Peak values for maximum isometric moments for each movement direction and selected kinematic and kinetic values were derived from the results. Differences between subjects with TFA and unimpaired were compared using a Mann-Whitney U Test and associations between groups by Spearman's rank correlation.ResultsThe participants with a TFA showed a significantly lower maximum isometric moment for hip abduction (0.85 vs. 1.41 Nm/kg p < .001), adduction (0.87 vs. 1.37 Nm/kg p = .001) and flexion (0.93 vs. 1.63 Nm/kg p = .010) compared to the reference group. Typically reported gait deviations in people with a TFA were identified, i.e. significant lower cadence and increased step width. We further identified altered coronal plane hip and trunk kinematics, with significantly higher ranges of motion during involved side stance-phase. Gait kinetics of individuals with a TFA showed significantly lower peak values during stance for hip abduction, adduction and extension moments in comparison to the reference group. We identified a moderate negative correlation between maximum isometric moment for hip abduction and trunk obliquity range of motion (ρ = -0.45) for participants with a TFA, which was not significant (p = 0.14).ConclusionWe showed that there are strength deficits in individuals with TFA and, that there are moderate correlations between gait deviations, i.e. lateral trunk lean during involved side stance and isometric hip abductor moment. The relation between maximum moments during gait and the corresponding maximum isometric moment may therefore be helpful to detect strength related compensation mechanisms. However, the moderate, non-significant correlation between lateral trunk lean and isometric hip abductor moment was the only one which corresponded directly to a gait deviation. Thus results must be interpreted with care. This study suggests that gait deviations in individuals with TFA are multifactorial and cannot be exclusively explained by their strength deficits. Future studies should explore the relationship between strength with kinematics and kinetics during gait in this population.

Project description:BackgroundFollowing an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation.MethodsCenter of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG).ResultsThere was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p < 0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p < 0.001), CoP velocity (p < 0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = - 0.59, EC: ρ = - 0.69).ConclusionThese results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control.Trial registrationDRKS00015254 , registered on September 20th, 2018.

Project description:ObjectiveThe purpose of this study was to qualitatively assess the first-hand lived experiences of patients with amputation who had transitioned from a traditional socket (TS) to Osseointegration (OI) to impact their overall quality of life (QOL) and function.MethodsThis was a qualitative phenomenological study. Participants who had a unilateral transfemoral amputation and fit the study's inclusion criteria were interviewed in a semi-structured format regarding their quality of life and function before and after transitioning from a traditional socket (TS) to Osseointegration (OI). Responses were then analyzed through line-by-line coding to determine themes that were relevant to QOL outcomes for this study.ResultsEleven participants were interviewed in this study. The qualitative analysis demonstrated an emergence of 6 main themes consisting of "Improved Quality of Life," "Supportive Community," "Previous Ill-fitting Socket," "Greater Function," "Improved Osseo-perception," and "Promotion of Community Accessibility". Strengths included the use of an OI-specific quality of life assessment with adapted questions from validated outcome measures, international participants, and use of thematic analysis for data analysis. Weaknesses included sample size, niche participant population, and OI as a revision procedure only. More research is still necessary to explore/determine the benefits and detriments of Osseointegration as an alternative to traditional sockets for prosthetic devices.ConclusionIndividuals who have undergone Osseointegration procedure discuss being more satisfied with their prosthesis and quality of life when compared to their previous experience of a traditional socket.Impact statementThis is a first of its kind study reporting on the lived experiences of those who have undergone OI. The field of amputation rehabilitation is expanding rapidly and knowing how this procedure impacts quality of life is important for healthcare professionals to understand as new frontiers are explored in this field.

Project description:Patients with transfemoral amputation (TFA) are at an increased risk of secondary musculoskeleteal comorbidities, primarily due to asymmetric joint loading. Amputated limb muscle weakness is also prevalent in the TFA population, yet all factors that contribute to muscle strength and thus joint loading are not well understood. Our objective was to bilaterally compare gluteus medius (GMED) muscle factors (volume, fatty infiltration, moment arm) that all contribute to joint loading in patients with TFA. Quantitative magnetic resonance (MR) images of the hip were collected from eight participants with unilateral TFA (2M/6F; age: 47.3 ± 14.7 y/o; BMI: 25.4 ± 5.3 kg/m2; time since amputation: 20.6 ± 15.0 years) and used to calculate normalized GMED muscle volume and fatty infiltration. Six participants participated in an instrumented gait analysis session that collected whole-body kinematics during overground walking. Subject-specific musculoskeletal models were used to calculate bilateral GMED (anterior, middle, posterior) moment arms and frontal plane hip joint angles across three gait cycles. Differences in volume, fatty infiltration, hip adduction-abduction angle, and peak moment arms were compared between limbs using paired Cohen's d effect sizes. Volume was smaller by 36.3 ± 18.8% (d = 1.7) and fatty infiltration was greater by 6.4 ± 7.8% (d = 0.8) in the amputated limb GMED compared to the intact limb. The amputated limb GMED abduction moment arms were smaller compared to the intact limb for both overground walking (anterior: d = 0.9; middle: d = 0.1.2) and during normal range of motion (anterior: d = 0.8; middle: d = 0.8) while bilateral hip adduction-abduction angles were similar during overground walking (d = 0.5). These results indicate that in patients with TFA, the amputated limb GMED is biomechanically disadvantaged compared to the intact limb, which may contribute to the etiology of secondary comorbidities. This population might benefit from movement retraining to lengthen the amputated limb GMED abduction moment arm during gait.

Dataset Information

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

Publications

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

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