Nolasco Luis A, Morgenroth David C, Silverman Anne K, Gates Deanna H
School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA.
VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
J Biomech. 2020 Aug 26;109:109926. doi: 10.1016/j.jbiomech.2020.109926. Epub 2020 Jul 2.
The sit-to-stand movement can be challenging for people with a transtibial amputation (TTA). The alignment of the prosthesis may influence the movement strategies people with TTA use to transfer from sit-to-stand by affecting foot placement. The purpose of this study was to determine how shifting the prosthetic foot anterior and posterior relative to the socket affects movement strategies used to transfer from sit-to-stand. To aid in interpretation, we compared movement strategies between people with and without TTA. Nine people with TTA and nine sex-, and age-matched non-amputee controls completed five self-paced sit-to-stand trials. With the posterior alignment, participants with TTA had 1) smaller braking GRF impulse on the prosthetic side and greater impulse on the intact side compared to the anterior alignment, 2) no significant differences between sides, which suggests greater braking impulse symmetry compared to anterior and prescribed alignments, and 3) smaller axial trunk range of motion compared to the prescribed alignment. There were also differences between participants with TTA and controls in braking GRF impulse, knee extension moment, anterior/posterior center of pressure position, and lateral and axial trunk range of motion. Based on these results, shifting the prosthetic foot posterior to the socket may be a useful tool to reduce braking impulse asymmetry and trunk motion in people with TTA during sit-to-stand. Thus, prosthetic alignment can have important implications for the comfort and ability of people with TTA to transfer from sit-to-stand as well as for development of secondary health conditions like low back pain, which is associated with compensatory movements.
对于经胫骨截肢（TTA）患者而言，从坐姿到站立的动作可能具有挑战性。假肢的对线可能会影响TTA患者从坐姿到站立时所采用的动作策略，因为它会影响足部的放置位置。本研究的目的是确定相对于接受腔前后移动假肢足部如何影响从坐姿到站立时所采用的动作策略。为了便于解释，我们比较了有TTA和无TTA患者之间的动作策略。9名TTA患者以及9名性别和年龄匹配的非截肢对照者完成了5次自定节奏的从坐姿到站立试验。在采用后对线时，与前对线相比，TTA患者1）假肢侧的制动地面反作用力（GRF）冲量较小，而健侧的冲量较大；2）两侧之间无显著差异，这表明与前对线和规定对线相比，制动冲量对称性更高；3）与规定对线相比，轴向躯干运动范围较小。TTA患者和对照者在制动GRF冲量、膝关节伸展力矩、前后压力中心位置以及横向和轴向躯干运动范围方面也存在差异。基于这些结果，将假肢足部移至接受腔后方可能是一种有用的方法，可减少TTA患者从坐姿到站立时的制动冲量不对称和躯干运动。因此，假肢对线对于TTA患者从坐姿到站立的舒适度和能力，以及对于诸如腰痛等与代偿性运动相关的继发性健康状况的发展可能具有重要影响。
