Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
Amsterdam Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
Arch Phys Med Rehabil. 2021 Jul;102(7):1340-1346.e3. doi: 10.1016/j.apmr.2021.02.007. Epub 2021 Mar 5.
The energy cost of walking with a lower limb prosthesis is higher than able-bodied walking and depends on both cause and level of amputation. This increase might partly be related to problems with balance control. In this study we investigated to what extent energy cost can be reduced by providing support through a handrail or cane and how this depends on level and cause of amputation.
Quasi-experimental study.
Rehabilitation gait laboratory.
Twenty-six people with a lower limb amputation were included: 9 with vascular and 17 with nonvascular causes, 16 at transtibial, and 10 at transfemoral or knee disarticulation level (N=26).
Participants walked on a treadmill with and without handrail support and overground with and without a cane.
Energy cost was assessed using respirometry.
On the treadmill, handrail support resulted in a 6% reduction in energy cost on average. This effect was attributed to an 11% reduction in those with an amputation attributable to vascular causes, whereas the nonvascular group did not show a significant difference. No interaction with level of amputation was found. Overground, no main effect of cane support was found, although an interaction effect with cause of amputation demonstrated a small nonsignificant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the nonvascular group when walking with a cane. The effect of support was positively correlated with self-selected walking speed.
This study demonstrates that providing external support can contribute to a reduction in energy cost in people with an amputation due to vascular causes with reduced walking ability while walking in the more challenging condition of the treadmill. Although it is speculated that this effect might be related to problems with balance control, this will need further investigation.
下肢假肢行走的能量消耗高于健全人行走，这取决于截肢的原因和水平。这种增加可能部分与平衡控制问题有关。本研究旨在调查通过扶手或拐杖提供支撑可以在多大程度上降低能量消耗，以及这取决于截肢的水平和原因。
准实验研究。
康复步态实验室。
共纳入 26 名下肢截肢者：9 名血管原因，17 名非血管原因，16 名胫骨截肢，10 名股骨截肢或膝关节离断（N=26）。
参与者在跑步机上和在地面上分别使用和不使用扶手支撑以及使用和不使用拐杖行走。
使用呼吸代谢仪评估能量消耗。
在跑步机上，扶手支撑平均使能量消耗降低 6%。这种效果归因于血管原因截肢者的能量消耗降低了 11%，而非血管原因截肢者则没有显著差异。未发现与截肢水平的交互作用。在地面上，未发现拐杖支撑的主要影响，但与截肢原因的交互作用表明，血管组的能量消耗略有非显著降低（3%），而非血管组的能量消耗显著增加（6%），当使用拐杖行走时。支撑的效果与自我选择的行走速度呈正相关。
本研究表明，在跑步机上更具挑战性的环境中，提供外部支撑可以帮助因血管原因而行走能力降低的截肢者降低能量消耗。虽然有人推测这种效果可能与平衡控制问题有关，但这需要进一步研究。
