Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
J Neuroeng Rehabil. 2024 Mar 7;21(1):35. doi: 10.1186/s12984-024-01331-y.
Persons with a transfemoral amputation (TFA) often experience difficulties in daily-life ambulation, including an asymmetrical and less stable gait pattern and a greater cognitive demand of walking. However, it remains unclear whether this is effected by the prosthetic suspension, as eliminating the non-rigid prosthetic connection may influence stability and cortical activity during walking. Spatiotemporal and stability-related gait parameters, as well as cortical activity during walking, were evaluated between highly active individuals (MFC-level K3-4) with a TFA and able-bodied (AB) persons, and between persons with a bone-anchored prosthesis (BAP) and those with a socket-suspended prosthesis (SSP).
18 AB persons and 20 persons with a unilateral TFA (10 BAP-users, 10 SSP-users) walked on a treadmill at their preferred speed. Spatiotemporal and margin of stability parameters were extracted from three-dimensional movement recordings. In addition, 126-channel electroencephalogram (EEG) was recorded. Brain-related activity from several cortical areas was isolated using independent component analysis. Source-level data were divided into gait cycles and subjected to time-frequency analysis to determine gait-cycle dependent modulations of cortical activity.
Persons with TFA walked with smaller and wider steps and with greater variability in mediolateral foot placement than AB subjects; no significant differences were found between BAP- and SSP-users. The EEG analysis yielded four cortical clusters in frontal, central (both hemispheres), and parietal areas. No statistically significant between-group differences were found in the mean power over the entire gait cycle. The event-related spectral perturbation maps revealed differences in power modulations (theta, alpha, and beta bands) between TFA and AB groups, and between BAP- and SSP-users, with largest differences observed around heel strike of either leg.
The anticipated differences in gait parameters in persons with TFA were confirmed, however no significant effect of the fixed suspension of a BAP was found. The preliminary EEG findings may indicate more active monitoring and control of stability in persons with TFA, which appeared to be timed differently in SSP than in BAP-users. Future studies may focus on walking tasks that challenge stability to further investigate differences related to prosthetic suspension.
股骨截肢（TFA）患者在日常生活中经常会遇到行走困难，包括步态不对称且不够稳定，以及行走时认知需求增加。然而，目前尚不清楚这是否是由假肢悬吊引起的，因为消除非刚性假肢连接可能会影响行走时的稳定性和皮质活动。本研究评估了高活动度股骨截肢（MFC 水平 K3-4）患者和健全人（AB）之间，以及骨锚式假体（BAP）使用者和接受传统 socket-suspended 假体（SSP）使用者之间的行走时时空和稳定性相关的步态参数以及皮质活动。
18 名 AB 个体和 20 名单侧 TFA 患者（10 名 BAP 用户，10 名 SSP 用户）以其自身偏好的速度在跑步机上行走。从三维运动记录中提取时空和稳定裕度参数。此外，还记录了 126 通道脑电图（EEG）。使用独立成分分析从几个皮质区域分离出与大脑相关的活动。将源级数据分为步态周期，并进行时频分析以确定皮质活动的步态周期依赖性调制。
TFA 患者的步长较小，步宽较大，左右脚放置的变化较大；与 BAP 使用者相比，无显著差异。EEG 分析在额区、中央区（双侧）和顶区产生了四个皮质簇。在整个步态周期内，平均功率在组间无统计学差异。事件相关频谱微扰图显示 TFA 和 AB 组之间以及 BAP 和 SSP 使用者之间的功率调制（θ、α 和β 波段）存在差异，在两腿的足跟触地时观察到最大差异。
TFA 患者的预期步态参数差异得到了证实，但 BAP 固定悬吊无显著影响。初步的 EEG 发现可能表明 TFA 患者对稳定性的监测和控制更为积极，在 SSP 中的时间与 BAP 使用者不同。未来的研究可能会集中在更具挑战性的稳定性行走任务上，以进一步研究与假肢悬吊相关的差异。
