Indian Journal of Physical Medicine and Rehabilitation

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VOLUME 29 , ISSUE 4 ( October-December, 2018 ) > List of Articles

RESEARCH ARTICLE

Energy Expenditure and Gait Parameters in Bilateral Transtibial Prostheses Users with and without Sleeve Suspension: A Pilot Study

Priya Gajendiran, Bobeena Rachel Chandy, Joyce Isaac, Bijesh Yadav, Rajdeep Ojha

Keywords : Energy expenditure, Gait parameters, Sleeve suspension,Bilateral transtibial amputee

Citation Information : Gajendiran P, Chandy BR, Isaac J, Yadav B, Ojha R. Energy Expenditure and Gait Parameters in Bilateral Transtibial Prostheses Users with and without Sleeve Suspension: A Pilot Study. Indian J Phy Med Rehab 2018; 29 (4):106-109.

DOI: 10.5005/jp-journals-10066-0032

License: CC BY-NC 4.0

Published Online: 00-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To compare the energy expenditure and gait parameters of bilateral transtibial prostheses user with and without sleeve suspension. Materials and methods: Five (4 male, 1 female) bilateral transtibial, patellar tendon bearing supracondylar (PTB-SC) prostheses users, 2 years postamputation, having good residual limbs and muscle power, were recruited in the study. Instrumented gait analysis, physiological cost index (PCI), timed up and go test (TUG), cadence and subjective feedback questionnaire were recorded on day 1 (without sleeve suspension) and day 15 (with sleeve suspension). Sleeve suspension was added with the prostheses on day 1. Adequate gait training for two weeks was provided to the participants. Wilcoxon signed-rank test was performed in SPSS 25.0 to compare the data recorded on days 1 and 15. p value less than 0.05 was considered as significant. Results: The p values of various gait parameters walking speed, percentage of stance, swing, single limb support and normalized stride length, cadence and TUG test were found to be not significant while p value of step width and physiological cost index was considered significant. All the five subjects have reported comfort in ambulation after wearing sleeve suspension. Conclusion: The study reports the effect of PTB-SC sleeve suspension in improving gait parameters and energy expenditure in five bilateral below knee amputee. Statistically significant improvement was reported in the cost of energy consumption and step width, suggesting that good prosthetic fitment is essential. However, the change in other gait parameters such as walking speed, percentage of stance, swing, single limb support, and stride length remained within normative data range. There is a need to conduct the study in a larger cohort with bilateral amputation where the essential component in prosthesis fitment, like sleeve suspension, can be varied, which in turn can give better stability and comfort resulting in improvement in walking efficiency.


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  1. Ziegler-Graham K, MacKenzie EJ, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008 Mar;89(3):422–429. DOI: 10.1016/j.apmr.2007.11.005.
  2. Ghosh Das Pooja LS. Prevalence and aetiology of amputation in Kolkata, India: A retrospective analysis. Hong Kong Physiother J 2013;31:36–40. DOI: 10.1016/j.hkpj.2012.12.002.
  3. De Fretes A, Boonstra AM, et al. Functional outcome of rehabilitated bilateral lower limb amputees. Prosthet Orthot Int 1994 Apr;18(1):18–24. DOI: 10.3109/03093649409164666.
  4. Waters RL. The energy expenditure of amputee gait. In: Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles; 2004.
  5. Su P-F, Gard SA, et al. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev 2007;44(4):491–501. DOI: 10.1682/JRRD.2006.10.0135.
  6. Wright DA, Marks L, et al. A comparative study of the physiological costs of walking in ten bilateral amputees. Prosthet Orthot Int 2008 Mar;32(1):57–67. DOI: 10.1080/03093640701669108.
  7. DuBow LL, Witt PL, et al. Oxygen consumption of elderly persons with bilateral below knee amputations: ambulation vs wheelchair propulsion. Arch Phys Med Rehabil 1983 Jun;64(6):255–259.
  8. Gonzalez EG, Corcoran PJ, et al. Energy expenditure in below-knee amputees: correlation with stump length. Arch Phys Med Rehabil 1974 Mar;55(3):111–119.
  9. Waters RL, Perry J, et al. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am 1976 Jan;58(1):42–46. DOI: 10.2106/00004623-197658010-00007.
  10. Eshraghi A, Abu Osman NA, et al. Gait biomechanics of individuals with transtibial amputation: effect of suspension system. PloS One 2014;9(5):e96988. DOI: 10.1371/journal.pone.0096988.
  11. Knapp S, Cummings D. Transtibial Amputation: Prosthetic Management. In: Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles; 2004.
  12. Mccollough NC, Jennings JJ, et al. Bilateral Below-the-knee Amputation in Patients Over Fifty Years of Age. Results in thirty-one patients. J Bone Joint Surg Am 1972 Sep;54(6):1217–1223.
  13. Gholizadeh H, Abu Osman NA, et al. A new approach for the pistoning measurement in transtibial prosthesis. Prosthet Orthot Int 2011 Dec;35(4):360–364. DOI: 10.1177/0309364611423130.
  14. Smith DG, Michael JW, et al. Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles, 3rd ed; 2004.
  15. Radiological evaluation of prosthetic fit in below-the-knee amputees. PubMed - NCBI [Internet]. [cited 2018 Oct 4].
  16. Gholizadeh H, Abu Osman NA, et al. Transtibial prosthesis suspension systems: systematic review of literature. Clin Biomech Bristol Avon 2014 Jan;29(1):87–97. DOI: 10.1016/j.clinbiomech.2013.10.013.
  17. Boutwell E, Stine R, et al. Effect of prosthetic gel liner thickness on gait biomechanics and pressure distribution within the transtibial socket. J Rehabil Res Dev 2012;49(2):227–240.
  18. Legro MW, Reiber G, et al. Issues of importance reported by persons with lower limb amputations and prostheses. J Rehabil Res Dev 1999 Jul;36(3):155–163.
  19. Kear BM, Guck TP, et al. Timed Up and Go (TUG) Test: Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors. J Prim Care Community Health 2017 Jan;8(1):9–13. DOI: 10.1177/2150131916659282.
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