Barnett C T, Polman R C J, Vanicek N
SHAPE Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia; School of Public Health, Tropical Medicine and Rehabilitation Science, James Cook University, Cairns, Australia.
Clin Biomech (Bristol). 2014 Aug;29(7):787-93. doi: 10.1016/j.clinbiomech.2014.05.012. Epub 2014 Jun 6.
Negotiating a raised surface during continuous gait is an important activity of daily living and is a potentially hazardous task with regards to trips, falls and fall-related injury. However, it is not known how recent transtibial amputees adapt to performing stepping gait tasks in the 6-month period following discharge from rehabilitation.
Recent transtibial amputees performed continuous gait trials, stepping onto and from a raised surface walkway representing the height of a street kerb, whilst kinematic and kinetic data were recorded at one, three and six months post-discharge from rehabilitation.
Walking speed increased when stepping down (p=0.04) and was invariant across the study period when stepping up. At one month post-discharge, participants displayed an affected lead limb preference (90.8%) when stepping down and an intact lead limb preference (70.0%) when stepping up, although these lead limb preferences diminished over time. Participants spent more time in stance on the intact limb compared to the affected limb in both stepping down (trail limb) (p=0.01) and stepping up (lead and trail limbs) (p=0.05). Participants displayed significantly greater joint mobility and power bursts in the intact trail limb when stepping down and in the intact lead limb when stepping up.
Transtibial amputees prefer to exploit intact limb function to a greater extent, although over time, the means by which this occurs changes which affects the initial lead limb preferences. The results from the current study enable future evidence-based therapeutic and prosthetic interventions to be designed that improve transtibial amputee stepping gait.
在持续行走过程中跨越一个凸起表面是一项重要的日常生活活动，并且就绊倒、摔倒及与摔倒相关的损伤而言是一项具有潜在危险性的任务。然而，尚不清楚近期的经胫骨截肢者在康复出院后的6个月期间如何适应执行跨步步态任务。
近期的经胫骨截肢者进行持续步态试验，踏上并离开一个代表街道路缘高度的凸起表面通道，同时在康复出院后的1个月、3个月和6个月记录运动学和动力学数据。
下台阶时步行速度增加（p = 0.04），上台阶时在整个研究期间保持不变。出院1个月时，参与者下台阶时表现出患侧肢体领先偏好（90.8%），上台阶时表现出健侧肢体领先偏好（70.0%），尽管这些肢体领先偏好会随着时间而减弱。与患侧肢体相比，参与者在下台阶（落后肢体）（p = 0.01）和上台阶（领先和落后肢体）（p = 0.05）时健侧肢体支撑时间更长。参与者在下台阶时健侧落后肢体以及在上台阶时健侧领先肢体表现出明显更大的关节活动度和功率爆发。
经胫骨截肢者更倾向于更大程度地利用健侧肢体功能，尽管随着时间推移，实现这一点的方式会发生变化，这会影响最初的肢体领先偏好。本研究结果有助于设计未来基于证据的治疗和假肢干预措施，以改善经胫骨截肢者的跨步步态。
