Armstrong Kiley, Brinkmann John T, Stine Rebecca, Gard Steven A, Major Matthew J
Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA.
Jesse Brown VA Medical Center, Chicago, IL, USA.
J Prosthet Orthot. 2019 Jul 22;Online first. doi: 10.1097/JPO.0000000000000333.
Intentional interruption of upper and lower limb coordination of able-bodied subjects alters their gait biomechanics. However, the effect of upper-limb loss (ULL) on lower-limb gait biomechanics is not fully understood. The aim of this secondary study was to perform a follow-up analysis of a previous dataset to characterize the spatiotemporal parameters and lower-limb kinematics and kinetics of gait for persons with ULL when wearing and not wearing an upper limb prosthesis (ULP). We were particularly interested in quantifying the effects of matching the mass and inertia of the prosthetic limb to the sound limb.
Ten persons with unilateral ULL walked at a self-selected speed under three randomly presented conditions: 1) not wearing a prosthesis, 2) wearing their customary prosthesis, and 3) wearing a mock prosthesis that can be adjusted to match the length, mass, and inertial properties of each subject's sound limb. Walkway-embedded force plates and a 12-camera digital motion capture system recorded ground reaction forces (GRFs) and retroreflective marker position data, respectively. Average spatiotemporal (walking speed, cadence, stance time, swing time, step length, double support time), lower-limb kinematic (joint angles), and lower-limb kinetic (ground forces, joint moments and powers) data were processed and their statistical significance were analyzed.
Walking speed for each condition was nearly equivalent (1.20±0.01 m/s) and differences between condition were non-significant (p=0.769). The interaction effect (side× prosthesis) was significant for peak hip extension (p=0.01) and second peak (propulsive) vertical GRF (p=0.028), but separate follow-up analyses of both main effects were not significant (p≥0.099). All other main effect comparisons were not significant (p≥0.102).
Although the sample cohort was small and heterogeneous, the results of this study suggest that persons with unilateral ULL did not display significant limb side asymmetry in lower-limb gait spatiotemporal, kinetic, and kinematic parameters, regardless of ULP use.
有意干扰健全受试者的上肢与下肢协调性会改变其步态生物力学。然而，上肢缺失（ULL）对下肢步态生物力学的影响尚未完全明确。这项二次研究的目的是对之前的数据集进行随访分析，以描述上肢缺失者在佩戴和不佩戴上肢假肢（ULP）时的时空参数以及下肢步态的运动学和动力学特征。我们特别关注量化使假肢肢体的质量和惯性与健全肢体相匹配所产生的影响。
10名单侧上肢缺失者在三种随机呈现的条件下以自选速度行走：1）不佩戴假肢；2）佩戴其惯用的假肢；3）佩戴可调节以匹配每个受试者健全肢体长度、质量和惯性特性的模拟假肢。嵌入人行道的测力板和12台摄像机的数字运动捕捉系统分别记录地面反作用力（GRF）和反光标记位置数据。对平均时空数据（行走速度、步频、站立时间、摆动时间、步长、双支撑时间）、下肢运动学数据（关节角度）和下肢动力学数据（地面力、关节力矩和功率）进行处理，并分析其统计学意义。
每种条件下的行走速度几乎相同（1.20±0.01米/秒），条件之间的差异无统计学意义（p = 0.769）。对于髋关节伸展峰值（p = 0.01）和第二个峰值（推进性）垂直GRF（p = 0.028），交互作用效应（侧别×假肢）具有统计学意义，但对两个主效应的单独随访分析均无统计学意义（p≥0.099）。所有其他主效应比较均无统计学意义（p≥0.102）。
尽管样本队列规模小且具有异质性，但本研究结果表明，单侧上肢缺失者在下肢步态的时空、动力学和运动学参数方面未表现出明显的肢体侧别不对称，无论是否使用上肢假肢。
