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Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

      Abstract

      Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.

      Objective

      To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.

      Design

      Intervention study with crossover design.

      Setting

      University research center.

      Participants

      Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.

      Intervention

      Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).

      Main Outcome Measures

      Physical function, gait, dynamic balance.

      Results

      The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.

      Conclusions

      Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.

      Key Words

      List of Abbreviations:

      2D (2-dimensional), ES (effect size), FSST (Four Square Step Test), PEQ (Prosthesis Evaluation Questionnaire), TUG (Timed Up and Go Test)
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      References

        • Paysant J.
        • Beyaert C.
        • Datie A.M.
        • Martinet N.
        • Andre J.M.
        Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees.
        J Rehabil Res Dev. 2006; 43: 153-160
        • Johansson J.
        • Sherill J.
        • Riley P.
        • Bonato P.
        • Herr H.
        A clinical comparison of variable-damping and mechanically passive prosthetic knee devices.
        Am J Phys Med Rehabil. 2005; 84: 563-575
        • Boonstra A.
        • Schrama J.M.
        • Eisma M.D.
        • Hof A.L.
        • Fidler E.V.
        Gait analysis of transfemoral amputee patients using prostheses with two different knee joints.
        Arch Phys Med Rehabil. 1996; 77: 515-520
        • Jaegers S.
        • Arendzen J.
        • de Jongh H.
        Prosthetic gait of unilateral transfemoral amputees: a kinematic study.
        Arch Phys Med Rehabil. 1995; 76: 736-743
        • Michaud S.
        • Gard S.
        • Childress D.
        A preliminary investigation of pelvic obliquity patterns during gait in persons with transtibial and transfemoral amputation.
        J Rehabil Res Dev. 2000; 37: 1-10
        • Orendurff M.
        • Segal A.D.
        • Klute G.K.
        • McDowell M.L.
        • Pecoraro J.A.
        • Czerniecki J.M.
        Gait efficiency using the C-Leg.
        J Rehabil Res Dev. 2006; 43: 239-246
        • Schmalz T.
        • Blumentritt S.
        • Jarasch R.
        Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components.
        Gait Posture. 2002; 16: 255-263
        • Jones S.
        • Twigg P.C.
        • Scally A.J.
        • Buckley J.G.
        The gait initiation process in unilateral lower-limb amputees when stepping up and stepping down to a new level.
        Clin Biomech. 2005; 20: 405-413
        • Jones S.
        • Twigg P.C.
        • Scally A.J.
        • Buckley J.G.
        The mechanics of landing when stepping down in unilateral lower-limb amputees.
        Clin Biomech. 2006; 21: 184-193
        • Tan J.
        Practical manual of physical medicine and rehabilitation: diagnostics, therapeutics, and basic problems.
        Mosby, St Louis1998
      1. MOBIS OttoBock Mobility System.
        Otto Bock Healthcare, Duderstadt, Germany2003
        • Montgomery J.
        • Hislop H.
        Daniels and Worthingham's muscle testing: techniques of manual examination.
        Saunders, Philadelphia1995
        • Gailey R.
        • Roach K.
        • Applegate B.
        • et al.
        The Amputee Mobility Predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate.
        Arch Phys Med Rehabil. 2002; 83: 613-627
        • Podsiadlo D.
        • Richardson S.
        The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Dite W.
        • Temple V.A.
        A clinical test of stepping and change of direction to identify multiple falling older adults.
        Arch Phys Med Rehabil. 2002; 83: 1566-1571
        • Boone D.
        • Coleman K.
        Use of the Prosthesis Evaluation Questionnaire (PEQ).
        J Prosthet Orthot. 2006; 18: 69-70
        • Miff S.C.
        • Childress D.S.
        • Gard S.A.
        • Meier M.R.
        • Hansen A.H.
        Temporal symmetries during gait initiation and termination in nondisabled ambulators and in people with unilateral transtibial limb loss.
        J Rehabil Res Dev. 2005; 42: 175-182
        • Patla A.
        • Prentice S.D.
        • Robinson C.
        • Neufield J.
        Visual control of locomotion: strategies for changing direction and for going over obstacles.
        J Exp Psychol Hum Percept Perform. 1991; 17: 603-604
        • Patla A.
        • Adkin A.
        • Ballard T.
        Online steering: coordination and control of body center of mass, head and body orientation.
        Exp Brain Res. 1999; 129: 629-634
        • Vincent W.
        Statistics in kinesiology.
        Human Kinetics, Champaign1995