MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Heliomare Research & Development, Relweg 51, 1949 EC Wijk aan Zee, The Netherlands.
MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
Gait Posture. 2014 Sep;40(4):616-21. doi: 10.1016/j.gaitpost.2014.07.013. Epub 2014 Jul 21.
The aim of this study was to examine whether impaired balance control is partly responsible for the increased energy cost of walking in persons with a lower limb amputation (LLA). Previous studies used external lateral stabilization to evaluate the energy cost for balance control; this caused a decrease in energy cost, with concomitant decreases in mean and variability of step width. Using a similar set-up, we expected larger decreases for LLA than able-bodied controls. Fifteen transtibial amputees (TT), 12 transfemoral amputees (TF), and 15 able-bodied controls (CO) walked with and without external lateral stabilization provided via spring like cords attached to the waist. Effects of this manipulation on energy cost, step parameters, and pelvic motion were evaluated between groups. TT (-5%) and CO (-3%) showed on average a small reduction in energy cost when walking with stabilization, whereas TF exhibited an increase in energy cost (+6.5%) The difference in the effect of stabilization was only significant between TT and TF. Step width, step width variability, and medio-lateral pelvic displacement decreased significantly with stabilization in all groups, especially in TT. Contrary to expectations, external lateral stabilization did not result in a larger decrease in the energy cost of walking for LLA compared to able-bodied controls, suggesting that balance control is not a major factor in the increased cost of walking in LLA. Alternatively, the increased energy cost with stabilization for TF suggests that restraining (medio-lateral) pelvic motion impeded necessary movement adaptations in LLA, and thus negated the postulated beneficial effects of stabilization on the energy cost of walking.
本研究旨在探讨下肢截肢（LLA）患者步行能量成本增加是否部分归因于平衡控制受损。先前的研究使用外部横向稳定来评估平衡控制的能量成本；这导致能量成本降低，同时步宽的均值和变异性也降低。使用类似的设置，我们预计LLA 比健全对照组的降幅更大。15 名胫骨截肢者（TT）、12 名股骨截肢者（TF）和 15 名健全对照组（CO）在使用和不使用通过连接到腰部的弹簧状绳索提供的外部横向稳定的情况下行走。评估了这种操作对能量成本、步幅参数和骨盆运动的影响。TT（-5%）和 CO（-3%）在使用稳定装置行走时平均能量成本略有降低，而 TF 则表现出能量成本增加（+6.5%）。稳定对 TT 和 TF 的影响的差异仅具有统计学意义。在所有组中，包括 TT，步宽、步宽变异性和骨盆横向位移均显著减小，而骨盆横向位移的减小幅度在 TT 中最大。与预期相反，与健全对照组相比，LLA 外部横向稳定并未导致步行能量成本更大幅度降低，这表明平衡控制不是 LLA 步行成本增加的主要因素。或者，TF 稳定时能量成本增加表明（横向）骨盆运动的限制阻碍了 LLA 中必要的运动适应，从而否定了稳定对步行能量成本的预期有益影响。
