Nepomuceno Antonia, Major Matthew J, Stine Rebecca, Gard Steven
1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.
Prosthet Orthot Int. 2017 Dec;41(6):556-563. doi: 10.1177/0309364617698521. Epub 2017 Mar 20.
The anatomical foot-ankle complex facilitates advancement of the stance limb through foot rockers and late-stance power generation during walking, but this mechanism is altered for persons with bilateral transtibial amputation when using passive prostheses.
To study the effects of bilateral foot and ankle immobilization on able-bodied gait to serve as a model for understanding gait of persons with bilateral transtibial amputation and associated compensatory mechanisms.
Comparative analysis.
Nine able-bodied persons walked at self-selected slow, normal, and fast speeds. They performed trials unaltered and when fitted with bilateral foot and ankle-immobilizing casts. Data from 10 individuals with bilateral transtibial amputation walking at self-selected fast speeds were used for qualitative comparison.
The average speeds for the able-bodied fast speed cast and normal speed no-cast trials were similar and were compared with bilateral transtibial amputation data. The able-bodied cast condition data more closely matched bilateral transtibial amputation data than the no-cast data. Ankle range-of-motion and power generation at pre-swing in the cast condition were markedly decreased, while trunk lateral flexion and transverse rotation range-of-motion and peak hip power generation increased.
Results suggest that the absence of active ankle range-of-motion and power generation contributes to the development of characteristic compensatory gait mechanisms displayed by persons with bilateral transtibial amputation. Clinical relevance This study helps to improve understanding of compensatory mechanisms resulting from reduced foot and ankle joint motion to inform lower limb prosthesis design and function for improving gait quality of individuals with bilateral transtibial amputation.
足部 - 踝关节复合体在行走过程中通过足 rocker 和支撑末期发力促进支撑腿前进，但对于使用被动假肢的双侧胫骨截肢者，这种机制会发生改变。
研究双侧足踝固定对健全人步态的影响，作为理解双侧胫骨截肢者步态及相关代偿机制的模型。
比较分析。
九名健全人以自我选择的慢、正常和快速度行走。他们在未改变状态下以及佩戴双侧足踝固定石膏时进行试验。来自 10 名双侧胫骨截肢者以自我选择的快速行走的数据用于定性比较。
健全人快速行走石膏试验和正常速度无石膏试验的平均速度相似，并与双侧胫骨截肢数据进行比较。与无石膏数据相比，健全人石膏状态数据与双侧胫骨截肢数据更接近匹配。在石膏状态下，摆动前期的踝关节活动范围和发力明显降低，而躯干侧屈和横向旋转活动范围以及髋部发力峰值增加。
结果表明，缺乏主动踝关节活动范围和发力会导致双侧胫骨截肢者出现特征性代偿步态机制。临床意义本研究有助于提高对因足踝关节活动减少而产生的代偿机制的理解，为下肢假肢设计和功能提供参考，以改善双侧胫骨截肢者的步态质量。
