Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study
Effects of extended powered knee prosthesis stance time via visual feedback on gait symmetry of individuals with unilateral amputation: a preliminary study
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DOI：
10.1186/s12984-019-0583-z
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发表时间：
2019-09-11
影响因子：
5.1
通讯作者：
Huang, He Helen
中科院分区：
文献类型：
--
作者：
Brandt, Andrea;Riddick, William;Huang, He Helen
背景建立步态对称性是截肢者康复的主要目标，使用动力假肢可能更容易实现。然而，根据以前的工作，我们假设用户在设备之间转移以前学习的运动模式，限制了更先进的假肢的功能。本研究的目的是初步探讨通过视觉反馈增加站立时间对使用动力和被动膝关节假体的截肢者步态对称性的影响。方法5例经股动脉截肢或膝关节离断的患者，在自行选择的速度下在跑步机上步行。视觉反馈被用来促进截肢站立时间的增加。个体由认证的假肢师安装市售的动力假肢，并在之前的访问中练习行走。在不同的日期使用被动膝关节和动力膝关节假体完成相同的方案。我们使用重复测量，双向方差分析（α = 0.05）来测试反馈和设备因素的显著影响。我们的主要测量结果是站立时间的不对称性、前后地面反作用力峰值和前推进力峰值的不对称性。结果通过视觉反馈增加截肢站立时间显著改善了使用两种假肢行走的个体的站立时间对称性（p = 0.012）和峰值推进对称性（p = 0.036）。与无反馈条件相比，使用动力膝关节假体时，最高反馈目标导致站立时间对称性提高36%，假体侧峰值推进力提高22%，峰值推进力对称性提高47%。反馈的变化与被动假体无差异，器械/假体类型的主要影响无统计学差异。然而，受试者与器械的相互作用是显著的，表明个体对每种器械的反应并不一致（例如，对于不同受试者，假体侧推进力与动力假体相比，动力假体侧推进力仍然相当或更大）。总的来说，在不同条件下，动力假体的假体侧峰值推进力平均值增加了31%，动力假体的峰值推进力不对称性改善了48%。结论通过视觉反馈增加假体侧站立时间有利于改善个体的时间和推进对称性。动力假肢通常能够实现更大的推进力，但个体适应每种设备的行为不同，需要进一步研究。
Background Establishing gait symmetry is a major aim of amputee rehabilitation and may be more attainable with powered prostheses. Though, based on previous work, we postulate that users transfer a previously-learned motor pattern across devices, limiting the functionality of more advanced prostheses. The objective of this study was to preliminarily investigate the effect of increased stance time via visual feedback on amputees' gait symmetry using powered and passive knee prostheses. Methods Five individuals with transfemoral amputation or knee disarticulation walked at their self-selected speed on a treadmill. Visual feedback was used to promote an increase in the amputated-limb stance time. Individuals were fit with a commercially-available powered prosthesis by a certified prosthetist and practiced walking during a prior visit. The same protocol was completed with a passive knee and powered knee prosthesis on separate days. We used repeated-measures, two-way ANOVA (alpha = 0.05) to test for significant effects of the feedback and device factors. Our main outcome measures were stance time asymmetry, peak anterior-posterior ground reaction forces, and peak anterior propulsion asymmetry. Results Increasing the amputated-limb stance time via visual feedback significantly improved the stance time symmetry (p = 0.012) and peak propulsion symmetry (p = 0.036) of individuals walking with both prostheses. With the powered knee prosthesis, the highest feedback target elicited 36% improvement in stance time symmetry, 22% increase in prosthesis-side peak propulsion, and 47% improvement in peak propulsion symmetry compared to a no feedback condition. The changes with feedback were not different with the passive prosthesis, and the main effects of device/ prosthesis type were not statistically different. However, subject by device interactions were significant, indicating individuals did not respond consistently with each device (e.g. prosthesis-side propulsion remained comparable to or was greater with the powered versus passive prosthesis for different subjects). Overall, prosthesis-side peak propulsion averaged across conditions was 31% greater with the powered prosthesis and peak propulsion asymmetry improved by 48% with the powered prosthesis. Conclusions Increasing prosthesis-side stance time via visual feedback favorably improved individuals' temporal and propulsive symmetry. The powered prosthesis commonly enabled greater propulsion, but individuals adapted to each device with varying behavior, requiring further investigation.