Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
Gait Posture. 2023 Sep;105:171-176. doi: 10.1016/j.gaitpost.2023.08.001. Epub 2023 Aug 4.
Unilateral lower limb amputees have asymmetrical gaits, particularly on irregular surfaces and slopes. It is unclear how coordination between arms and legs can adapt during cross-slope walking.
How do transfemoral amputees (TFAs) adapt their upper-lower limb coordination on cross-slope surfaces?
Twenty TFA and 20 healthy adults (Ctrl) performed a three-dimensional gait analysis in 2 walking conditions: level ground and cross-slope with prosthesis uphill. Sagittal joint angles and velocities of hips and shoulders were calculated. Continuous relative phases (CRP) were computed between the shoulder and the hip of the opposite side. The closer to 0 the CRP is, the more coordinated the joints are. Curve analysis were conducted using SPM.
The mean CRP between the downhill shoulder and the uphill hip was higher in TFA compared to Ctrl (p = 0.02), with a walking conditions effect (p = 0.005). TFA showed significant differences about the end of the stance phase (p = 0.01) between level ground and cross-slope, while Ctrl showed a significant difference (p = 0.008) between these walking conditions at the end of the swing phase. In CRP between the uphill shoulder and the downhill hip, SnPM analysis showed intergroup differences during the stance phase (p < 0.05), but not in the comparison between walking conditions in TFA and Ctrl groups.
TFA showed an asymmetrical coordination in level ground walking compared to Ctrl. Walking on cross-slope led to upper-lower limb coordination adaptations: this condition impacted the CRP between downhill shoulder and uphill hip in both groups. The management of the prosthetic limb, positioned uphill, induced a reorganization of the coordination with the upper limb of the amputated side. Identifying upper-lower limb coordination adaptations on cross-slope surfaces will help to achieve rehabilitation goals for effective walking in urban environments.
单侧下肢截肢者的步态不对称，尤其是在不平整的表面和斜坡上。目前尚不清楚在过斜坡行走时手臂和腿部之间的协调如何适应。
股骨截肢者（TFAs）如何在过斜坡表面适应上下肢协调？
20 名 TFAs 和 20 名健康成年人（Ctrl）在 2 种行走条件下进行了三维步态分析：平地和上坡假肢的过斜坡。计算髋关节和肩部的矢状面关节角度和速度。计算对侧肩部和臀部的连续相对相位（CRP）。CRP 越接近 0，关节协调性越好。使用 SPM 进行曲线分析。
与 Ctrl 相比，TFA 下坡肩部与上坡臀部的平均 CRP 更高（p=0.02），且行走条件有影响（p=0.005）。TFA 在平地和过斜坡的站立相末期有显著差异（p=0.01），而 Ctrl 在摆动相末期有显著差异（p=0.008）。在 CRP 中，在上坡肩部与下坡臀部之间，SnPM 分析显示组间在站立相有差异（p<0.05），但在 TFA 和 Ctrl 组的行走条件之间的比较中没有差异。
TFA 在平地行走时与 Ctrl 相比表现出不对称的协调。在过斜坡行走会导致上下肢协调适应：这种情况会影响两组中下坡肩部和上坡臀部之间的 CRP。上坡位置的假肢管理会导致对截肢侧上肢协调的重新组织。识别过斜坡表面的上下肢协调适应将有助于实现在城市环境中有效行走的康复目标。
