Gait compensatory mechanisms in unilateral transfemoral amputees. (March 2020)

• Record Type: Journal Article
• Authors: Harandi, Vahidreza Jafari; Ackland, David Charles; Haddara, Raneem; Lizama, L. Eduardo Cofré; Graf, Mark; Galea, Mary Pauline; Lee, Peter Vee Sin
• Is Part Of: Medical engineering & physics. Volume 77(2020)
• Page Start: 95
• Page End: 106
• Publication Date: 2020-03
• Subjects: Gait -- Muscle coordination -- Musculoskeletal modelling -- Transfemoral; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2019.11.006
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: Transfemoral amputees adopt compensatory strategies during walking. Intact limb hip muscles have critical roles on mediolateral balance. The prosthesis provides prominent support, progression and breaking during stance. Increased pelvis tilt towards residual limb was associated with reduced hip motion. Abstract: Individuals with unilateral transfemoral amputation depend on compensatory muscle and joint function to generate motion of the lower limbs, which can produce gait asymmetry; however, the functional role of the intact and residual limb muscles of transfemoral amputees in generating progression, support, and mediolateral balance of the body during walking is not well understood. The aim of this study was to quantify the contributions of the intact and the residual limb's contralateral muscles to body center of mass (COM) acceleration during walking in transfemoral amputees. Three-dimensional subject-specific musculoskeletal models of 6 transfemoral amputees fitted with a socket-type prosthesis were developed and used to quantify muscle forces and muscle contributions to the fore-aft, vertical, and mediolateral body COM acceleration using a pseudo-inverse ground reaction force decomposition method during over-ground walking. Anterior pelvic tilt and hip range of motion in the sagittal and frontal planes of the intact limb was significantly larger than those in the residual limb ( p <0.05). The mean contributions of the intact limb hip muscles to body COM support, forward propulsion and mediolateral balance were significantly greater than those in the residual limb ( p <0.05). Gluteus maximus contributed more to propulsion and support, while gluteus medius contributed more to balance than other muscles in the intact limb than the residual limb. The findings demonstrate the role of the intact limb hip musculature in compensating for reduced or absent muscles and joint function in the residual limb of transfemoral amputees during walking. The results may be useful in developing rehabilitation programs and design of prostheses to improve gait symmetry and mitigate post-operative musculoskeletal pathology.