Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA.
Military Performance Lab, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
J Biomech. 2014 May 7;47(7):1675-81. doi: 10.1016/j.jbiomech.2014.02.033. Epub 2014 Mar 6.
Lower limb amputation substantially disrupts motor and proprioceptive function. People with lower limb amputation experience considerable impairments in walking ability, including increased fall risk. Understanding the biomechanical aspects of the gait of these patients is crucial in improving their gait function and their quality of life. In the present study, 9 persons with unilateral transtibial amputation and 13 able-bodied controls walked on a large treadmill in a Computer Assisted Rehabilitation Environment (CAREN). While walking, subjects were either not perturbed, or were perturbed either by continuous mediolateral platform movements or by continuous mediolateral movements of the visual scene. Means and standard deviations of both step lengths and step widths increased significantly during both perturbation conditions (all p<0.001) for both groups. Measures of variability, local and orbital dynamic stability of trunk movements likewise exhibited large and highly significant increases during both perturbation conditions (all p<0.001) for both groups. Patients with amputation exhibited greater step width variability (p=0.01) and greater trunk movement variability (p=0.04) during platform perturbations, but did not exhibit greater local or orbital instability than healthy controls for either perturbation conditions. Our findings suggest that, in the absence of other co-morbidities, patients with unilateral transtibial amputation appear to retain sufficient sensory and motor function to maintain overall upper body stability during walking, even when substantially challenged. Additionally, these patients did not appear to rely more heavily on visual feedback to maintain trunk stability during these walking tasks.
下肢截肢大大破坏了运动和本体感觉功能。下肢截肢的人在行走能力方面会出现相当大的障碍，包括增加摔倒的风险。了解这些患者步态的生物力学方面对于改善他们的步态功能和生活质量至关重要。在本研究中，9 名单侧胫骨截肢患者和 13 名健康对照组在计算机辅助康复环境（CAREN）中在大型跑步机上行走。在行走过程中，受试者要么不受干扰，要么受到连续的横向平台运动或连续的视觉场景横向运动的干扰。在两种干扰条件下，两组的步长和步宽的平均值和标准差都显著增加（均 p<0.001）。躯干运动的变异性、局部和轨道动力学稳定性的测量值在两种干扰条件下也都显著增加（均 p<0.001）。在平台干扰下，截肢患者的步宽变异性更大（p=0.01），躯干运动变异性更大（p=0.04），但与健康对照组相比，无论是哪种干扰条件，他们的局部或轨道不稳定性都没有更大。我们的研究结果表明，在没有其他合并症的情况下，单侧胫骨截肢患者似乎在行走时保留了足够的感觉和运动功能来维持整体上半身的稳定性，即使受到了很大的挑战。此外，这些患者在进行这些行走任务时似乎并没有更依赖视觉反馈来维持躯干稳定性。
