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Changes in Trunk and Pelvis Motion Among Persons With Unilateral Lower Limb Loss During the First Year of Ambulation

  • Caitlin E. Mahon
    Affiliations
    DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland

    Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
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  • Courtney M. Butowicz
    Affiliations
    Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
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  • Christopher L. Dearth
    Affiliations
    DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland

    Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland

    Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
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  • Brad D. Hendershot
    Correspondence
    Corresponding author Brad D. Hendershot, PhD, 4494 N. Palmer Road, America Building (19), Room B320, Bethesda, MD, 20889.
    Affiliations
    DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland

    Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland

    Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Published:September 19, 2019DOI:https://doi.org/10.1016/j.apmr.2019.08.476

      Abstract

      Objective

      To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized.

      Design

      Inception cohort with up to 5 repeated evaluations, including both biomechanical and subjective outcomes, during a 1-year period (0, 2, 4, 6, 12 months) after initial ambulation with a prosthesis.

      Setting

      Biomechanics laboratory within military treatment facility.

      Participants

      Twenty-two men with unilateral transtibial limb loss and 10 men with unilateral transfemoral limb loss (N=32).

      Interventions

      Not applicable.

      Main Outcome Measures

      Triplanar trunk-pelvis range of motion and intersegmental coordination (continuous relative phase) obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking velocities. Self-reported presence and intensity of low back pain.

      Results

      An interaction effect between time and group existed for sagittal (P=.039) and transverse (P=.009) continuous relative phase at self-selected walking velocity and transverse trunk range of motion (P=.013) and sagittal continuous relative phase (P=.005) at controlled walking velocity. Trunk range of motion generally decreased, and trunk-pelvis coordination generally increased with increasing time after initial ambulation. Sagittal trunk and pelvis range of motion were always less and frontal trunk-pelvis coordination was always greater for persons with more distal limb loss. Low back pain increased for persons with transtibial limb loss and decreased for persons with transfemoral limb loss following the 4-month time point.

      Conclusions

      Temporal changes (or lack thereof) in features of trunk-pelvis motions within the first year of ambulation help elucidate relationships between (biomechanical) risk factors for low back pain after limb loss.

      Keywords

      List of abbreviations:

      CRP (continuous relative phase), LBP (low back pain), ROM (range of motion), SSWV (self-selected walking velocity), TF (transfemoral), TT (transtibial), WV (walking velocity)
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