Gait differences between K3 and K4 persons with transfemoral amputation across level and non-level walking conditions
Gait differences between K3 and K4 persons with transfemoral amputation across level and non-level walking conditions
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DOI：
10.1177/0309364618785724
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发表时间：
2018-12-01
影响因子：
1.5
通讯作者：
Baddour, Natalie
中科院分区：
文献类型：
--
作者：
Sturk, James A.;Lemaire, Edward D.;Baddour, Natalie
背景：经股动脉截肢者的功能水平可以从K级0（最低）到K级4（最高）分类。了解K3和K4经股截肢术之间的生物力学差异有助于为临床专业人员和研究人员提供截肢者护理和步态评估方面的信息。目的：探索不同表面条件下K3和K4节段经股动脉截肢术之间的步态差异。研究设计：横断面研究。研究方法：四个K3和六个K4经股截肢和10个匹配的健全的个人走在虚拟环境中与模拟的水平和非水平表面上的自步速跑步机。稳定性指标包括内外侧稳定性边缘、步长参数和步态变异性（速度标准差、时空参数、内外侧躯干加速度的均方根）。结果如下：K3比K4走得慢，步幅更宽，内侧-外侧躯干加速度的均方根更大，内侧-外侧稳定性标准差更大，表明其稳定性受到进一步挑战。K3参与者在内外侧方向的双支撑时间和躯干加速度均方根方面具有更大的不对称性，但总体上相似。K3参与者与AB之间的差异更大，且参数比K4更多，尽管K4与AB之间在躯干加速度均方根（内侧-外侧方向）、步行速度和双支撑时间标准差方面存在差异。结论：研究结果提高了我们对斜坡和模拟不平表面上K3和K4经股截肢步态的理解。临床相关性高性能和社区走动的经股截肢者无法与健全个体的走动能力相匹配。了解这些群体在挑战平衡的条件下的步态差异，需要制定康复方案和假体部件，以改善经股截肢者的步态和在其选择的环境中的整体活动性。
Background: A transfemoral amputee's functional level can be classified from K-level 0 (lowest) to K-level 4 (highest). Knowledge of the biomechanical differences between K3 and K4 transfemoral amputation could help inform clinical professionals and researchers in amputee care and gait assessment. Objectives: Explore gait differences between K3- and K4-level transfemoral amputation across different surface conditions. Study design: Cross-sectional study. Methods: Four K3 and six K4 transfemoral amputation and 10 matched able-bodied individuals walked in a virtual environment with simulated level and non-level surfaces on a self-paced treadmill. Stability measures included medial-lateral margin of stability, step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, root-mean-square of medial-lateral trunk acceleration). Results: K3 walked slower than K4 with wider steps, greater root-mean-square of medial-lateral trunk acceleration, and greater medial-lateral margin of stability standard deviations, indicating their stability was further challenged. K3 participants had greater asymmetry in double support time and trunk acceleration root-mean-square in the medial-lateral direction, but similar asymmetry overall. K3 participants had larger differences from AB and in more parameters than K4, although K4 differed from AB in trunk acceleration root-mean-square in the medial-lateral direction, walking speed, and double support time standard deviations. Conclusion: The findings improve our understanding of K3 and K4 transfemoral amputation gait on slopes and simulated uneven surfaces. Clinical relevance High performing and community ambulatory transfemoral amputees cannot match the ambulatory abilities of ablebodied individuals. Understanding gait differences between these groups under conditions that challenge balance is required to develop rehabilitation protocols and prosthetic componentry targeted at improving transfemoral amputeegait and overall mobility in their chosen environment.