Temporal spatial and metabolic measures of walking in highly functional individuals with lower limb amputations

Jarvis, HL; Bennett, AN; Twiste, M; Phillip, RD; Etherington, J; Baker, RJ

Abstract

OBJECTIVE:
The aim of this descriptive exploratory study is to record the temporal spatial parameters and metabolic energy expenditure during walking of individuals with amputation, walking with advanced prostheses and following completion of comprehensive rehabilitation, to able-bodied controls.

DESIGN:
Cross-sectional

SETTING: Multi-disciplinary comprehensive rehabilitation centre

PARTICIPANTS: Thirty severely injured United Kingdom military personnel with amputation and subsequent completion of their rehabilitation programme (10 unilateral trans-tibial, 10 unilateral trans-femoral, and 10 bilateral trans-femoral) were compared to (and of similar age, height and mass (p < 0.537) as) 10 able-bodied controls.

INTERVENTIONS:
Not applicable Main Outcomes and Measures: Temporal spatial and metabolic energy expenditure data were captured during walking on level ground at self-selected speed.

RESULTS:
The individuals with amputation were all male, with a mean age 29 years (SD = 4) and mean New Injury Severity Score of 31 (SD = 16). Walking speed, stride length, step length and cadence of individuals with a unilateral trans-tibial or trans-femoral amputation was comparable to controls, and only for individuals with a bilateral trans-femoral amputation was walking speed significantly slower (1·12m/s, p = 0.025) and cadence reduced (96 steps/min, p = 0.026). Oxygen cost for individuals with a unilateral trans-tibial amputation (0·15 ml/kg/m) was the same as for controls (0·15 ml/kg/m), and significantly increased by 20% (0·18ml/kg/m, p = 0.023) for unilateral trans-femoral and by 60% (0·24 ml/kg/m, p < 0.001) for bilateral trans-femoral individuals with amputation.

CONCLUSION:
The scientific literature reports a wide range of gait and metabolic energy expenditure across individuals with amputation. The results of this study indicate that the individuals with amputation have a gait pattern which is highly functional and efficient. This is comparable to a small number of studies reporting similar outcomes for individuals with a unilateral trans-tibial amputation, but the results from this study are better than those on individuals with trans-femoral amputations reported elsewhere, despite comparison with populations wearing similar prosthetic componentry. Those studies that do report similar outcomes have included individuals who have been provided with a comprehensive rehabilitation programme. This suggests that such a programme may be as important as, or even more important than, prosthetic component selection in improving metabolic energy expenditure. The data are made available as a benchmark for what is achievable in the rehabilitation of some individuals with amputations, but agreeably may not be possible for all amputees to achieve.

Citation

Jarvis, H., Bennett, A., Twiste, M., Phillip, R., Etherington, J., & Baker, R. (2017). Temporal spatial and metabolic measures of walking in highly functional individuals with lower limb amputations. Archives of Physical Medicine and Rehabilitation, 98(7), 1389-1399. https://doi.org/10.1016/j.apmr.2016.09.134

• Journal Article Type: Article
• Acceptance Date: Sep 30, 2016
• Online Publication Date: Nov 16, 2016
• Publication Date: Jul 1, 2017
• Deposit Date: Nov 28, 2016
• Publicly Available Date: Nov 16, 2017
• Journal: Archives of Physical Medicine and Rehabilitation
• Print ISSN: 0003-9993
• Publisher: Elsevier
• Volume: 98
• Issue: 7
• Pages: 1389-1399
• DOI: https://doi.org/10.1016/j.apmr.2016.09.134
• Publisher URL: http://dx.doi.org/10.1016/j.apmr.2016.09.134
• Related Public URLs: http://www.journals.elsevier.com/archives-of-physical-medicine-and-rehabilitation/
• Additional Information: Funders : Royal Centre for Defence Medicine; Projects : A scientific basis for improving function in trans-femoral amputee; Grant Number: DEFCON 705