University of Utah, Department of Physical Therapy and Athletic Training, United States of America; Veterans Affairs Salt Lake City Health Care System, United States of America; University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America.
University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; High Point University, Department of Physical Therapy, United States of America.
Clin Biomech (Bristol). 2020 Dec;80:105102. doi: 10.1016/j.clinbiomech.2020.105102. Epub 2020 Jul 7.
Movement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown.
Kinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Analysis of covariance was used to compare sagittal-plane peak knee moment and joint angle (primary) and hip and ankle moments and joint angles, vertical ground reaction force and impulse (secondary).
Within transtibial amputation group comparisons showed significantly greater between-limb asymmetry in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .05), peak ankle angle (p < .01) and peak ankle moment (p < .01) with the step ascent task compared to overground walking. The transtibial amputation group had greater between-limb asymmetry during step ascent in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .04) and peak ankle angle (p < .01) than healthy matched peers. During overground walking, the transtibial amputation group had greater between-limb asymmetry in peak vertical impulse (p = .05) and peak ankle moment (p < .01) than healthy matched peers.
Movement asymmetry is increased during step ascent compared to overground walking for adults with transtibial amputation. While the restoration of overground walking is the focus of post-amputation rehabilitation and prosthetic design, higher demand tasks should also be considered to maximize mobility for adults with transtibial amputation.
小腿截肢后，成年人通常会出现下肢运动不对称。然而，低需求和高需求功能任务之间的运动不对称程度尚不清楚。
对两组人群进行了地面行走（低需求）和台阶上升（高需求）任务的运动学和动力学数据采集：1）小腿截肢者；2）健康匹配的同龄人。协方差分析用于比较矢状面峰值膝关节力矩和关节角度（主要指标）以及髋关节和踝关节力矩和关节角度、垂直地面反作用力和冲量（次要指标）。
在小腿截肢组内比较中，与地面行走相比，台阶上升任务时峰值膝关节力矩（p<.01）、垂直冲量（p<.01）、峰值垂直地面反作用力（p=.05）、峰值踝关节角度（p<.01）和峰值踝关节力矩（p<.01）的两腿间不对称性显著更大。与健康匹配的同龄人相比，小腿截肢组在台阶上升时的峰值膝关节力矩（p<.01）、垂直冲量（p<.01）、峰值垂直地面反作用力（p=.04）和峰值踝关节角度（p<.01）的两腿间不对称性更大。在地面行走时，与健康匹配的同龄人相比，小腿截肢组的峰值垂直冲量（p=.05）和峰值踝关节力矩（p<.01）的两腿间不对称性更大。
与地面行走相比，小腿截肢成年人在台阶上升时运动不对称性增加。虽然术后康复和假肢设计的重点是恢复地面行走，但也应考虑更高需求的任务，以最大限度地提高小腿截肢成年人的活动能力。
