Howard Charla L, Wallace Chris, Perry Bonnie, Stokic Dobrivoje S
Division of Orthotics and Prosthetics, Methodist Rehabilitation Center, Jackson, MS, USA.
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
Prosthet Orthot Int. 2020 Jun;44(3):133-144. doi: 10.1177/0309364620909049. Epub 2020 Mar 18.
Despite increasing knowledge about the potential benefits of advanced user-controlled technology, the decision about switching an individual prosthesis user from a non-microprocessor prosthetic knee to a microprocessor prosthetic knee is mainly based on clinician's experience rather than empirical evidence.
To demonstrate the utility of single-subject design and data analysis for evaluating changes in temporal-spatial gait characteristics between walking with a non-microprocessor prosthetic knee and microprocessor prosthetic knee.
Single-subject ABA/BAB design.
Seven non-microprocessor prosthetic knee users (all men, age 50-84 years, 3-40 years post-amputation) were transitioned through the ABA or BAB phases (A-NMPK, B-MPK, 5 weeks each). Four weekly gait evaluations were performed at three self-selected speeds with an electronic walkway. The non-microprocessor prosthetic knee-microprocessor prosthetic knee differences in stride length-cadence relationship, prosthetic weight acceptance, single-limb support, and step width were evaluated for each subject using the "non-overlap of all pairs" statistical method.
Most subjects improved temporal-spatial gait while on the microprocessor prosthetic knee; in only one subject, none of the 10 gait parameters were in favor of the microprocessor prosthetic knee. In the BAB group, longer use of the microprocessor prosthetic knee was associated with shorter prosthetic weight acceptance and longer single-limb support times across three speeds. Step width either improved with the microprocessor prosthetic knee or remained unchanged in most subjects.
The evidence of individual subject improvements in gait coordination, greater reliance on the prosthetic side, and better stability with the microprocessor prosthetic knee than non-microprocessor prosthetic knee over a range of walking speeds demonstrate the practical utility of the single-subject method in clinical decision-making.
The results demonstrate the use of the single-subject method for examining person-specific differences in temporal-spatial gait characteristics between walking with a non-microprocessor prosthetic knee and microprocessor prosthetic knee at three self-selected speeds. The method proved feasible and reliable for documenting changes in gait at the individual level, which is relevant for clinical practice.
尽管人们对先进的用户控制技术的潜在益处的了解日益增加，但决定将个体假肢使用者从非微处理器假肢膝关节转换为微处理器假肢膝关节主要基于临床医生的经验，而非实证依据。
证明单受试者设计和数据分析在评估使用非微处理器假肢膝关节和微处理器假肢膝关节行走时时空步态特征变化方面的实用性。
单受试者ABA/BAB设计。
7名非微处理器假肢膝关节使用者（均为男性，年龄50 - 84岁，截肢后3 - 40年）经历ABA或BAB阶段（A - 非微处理器假肢膝关节，B - 微处理器假肢膝关节，各5周）。使用电子步道以三种自我选择的速度每周进行四次步态评估。使用“所有对不重叠”统计方法为每个受试者评估非微处理器假肢膝关节与微处理器假肢膝关节在步幅长度 - 步频关系、假肢承重、单腿支撑和步宽方面的差异。
大多数受试者在使用微处理器假肢膝关节时改善了时空步态；仅一名受试者的10个步态参数中没有一个有利于微处理器假肢膝关节。在BAB组中，在三种速度下，更长时间使用微处理器假肢膝关节与更短的假肢承重时间和更长的单腿支撑时间相关。在大多数受试者中，步宽要么因微处理器假肢膝关节而改善，要么保持不变。
个体受试者在步态协调性方面有所改善、对假肢侧的依赖性增强以及在一系列行走速度下使用微处理器假肢膝关节比非微处理器假肢膝关节具有更好稳定性的证据，证明了单受试者方法在临床决策中的实际实用性。
结果证明了使用单受试者方法来检查在三种自我选择的速度下使用非微处理器假肢膝关节和微处理器假肢膝关节行走时个体特定的时空步态特征差异。该方法被证明对于记录个体水平的步态变化是可行且可靠的，这与临床实践相关。
