The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait
The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait
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DOI：
10.1016/j.clinbiomech.2013.10.012
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发表时间：
2014-01-01
影响因子：
1.8
通讯作者：
Howard, David
中科院分区：
文献类型：
--
作者：
Major, Matthew J.;Twiste, Martin;Howard, David
背景：以往市场上可获得的经胫骨假体部件的研究一直无法清楚地了解假体的机械性能和使用者性能(即步态质量和能量消耗)之间的关系，了解其中的关系是改进假体设计和处方的关键。这些研究中的许多都受到限制，因为没有描述测试假体的机械性能和/或仅考虑以自我选择的速度进行水平行走。本研究的目的是根据日常行走中的不同步行条件，系统地研究踝关节旋转刚度对经胫骨截肢者步态的影响。方法：对5例单侧创伤性经胫骨截肢者在水平、倾斜5%和下降5%的水平行走时的踝关节和膝关节运动学、假肢正常地面反作用力和净代谢费用进行了测量。结果：总体来说，较低的背屈刚度导致假体侧背屈运动较大，膝关节侧屈曲声音较大。在假体支撑的负荷阶段减少了正常的地面反作用力，减少了净代谢成本。解释：几乎没有观察到足底屈曲僵硬的变化，很可能是因为足部早期实现了足部平坦。较低的背屈僵硬通常会改善步态表现，这似乎是由于站立时胫骨更容易前进所致。然而，观察到的差异很小，这表明更大范围的步行和僵硬条件将有助于在未来的研究中充分探索这些影响。(C)2013爱思唯尔有限公司。保留所有权利。
Background: Previous studies of commercially-available trans-tibial prosthetic components have been unable to provide clear insight into the relationships between prosthetic mechanical properties and user performance (i.e., gait quality and energy expenditure), the understanding of which is key to improving prosthesis design and prescription. Many of these studies have been limited by not characterising the mechanical properties of the tested prostheses and/or only considered level walking at self-selected speeds. The aim of this study was to conduct a systematic investigation of the effects of ankle rotational stiffness on trans-tibial amputee gait during various walking conditions reflective of those encountered during daily ambulation.Methods: Ankle and knee kinematics, prosthetic limb normal ground reaction forces, and net metabolic cost were measured in five traumatic unilateral trans-tibial amputees during treadmill walking on the level, a 5% incline and a 5% decline whilst using an experimental articulated prosthetic foot with four different rotational stiffness setups and without changes in alignment between conditions.Findings: Overall, lower dorsiflexion stiffness resulted in greater prosthetic side dorsiflexion motion and sound side knee flexion, reduced normal ground reaction force during the loading phase of prosthetic stance and reduced net metabolic cost.Interpretation: Few differences were observed with changes in plantarflexion stiffness, most likely due to the foot achieving early foot flat. Low dorsiflexion stiffness generally improved gait performance seemingly due to easier tibial progression during stance. However, observed differences were small, suggesting that a wider range of walking and stiffness conditions would be useful to fully explore these effects in future studies. (C) 2013 Elsevier Ltd. All rights reserved.