RESUMEN
OBJECTIVE: To compare energy cost of walking (ECW) and prosthesis-related perceived mobility with the Marlo Anatomical Socket (MAS(®)) and the Ischial Containment (IC) Socket. METHOD: Transfemoral (TF) amputees were enrolled in the study. ECW tests were conducted inside, in a hallway with a regular floor surface. Subjects had to walk back and forth on a 61m linear course at their own self-selected speed. Metabolic and heart rate data were collected during the walking test using a portable gas analyzer. All measurements were made at steady state (SS). The tests were performed first using the IC socket and then after 30 days of MAS(®) use; the last test was carried out after 60 days of MAS(®) use. The amputees were also administered the Prosthetic Evaluation Questionnaire Mobility Section (PEQ MS) at the first and the last test to assess perceived potential for mobility using the prosthesis. RESULTS: Seven long-term prosthesis users were analyzed. Their mean age was 33.9±9.3 years; all were employed, active, and used IC sockets. At the third walking test, the ECW with the MAS(®) was significantly lower than that with the IC socket (p=.016). PEQ MS data also improved significantly at the last evaluation (p<.018). CONCLUSION: Results suggest that using the MAS(®), lowering the ECW and improving PEQ MS, could be a valid prosthesis design for active TF amputees compared to their usual IC socket.
Asunto(s)
Amputados , Miembros Artificiales , Metabolismo Energético , Caminata/fisiología , Adulto , Humanos , Pierna/cirugía , Persona de Mediana Edad , Consumo de Oxígeno , Diseño de PrótesisRESUMEN
Measuring the energy cost of walking (ECW) is a valid way of assessing the walking efficiency of subjects who were prosthetic users following lower limb amputation. The aim of this study was to determine whether, in these subjects, treadmill and floor ECW measurements are comparable. We tested 24 subjects who had undergone unilateral lower limb amputations for vascular diseases as they walked at a self-selected comfortable speed on the floor and on a treadmill. The tests were conducted at the end of rehabilitative treatment to fit prosthesis. Eight subjects underwent transtibial and 16 transfemoral amputation. The measurements were taken with a portable gas analyzer. The self-selected comfortable speed on the treadmill was significantly lower than that on the floor, where the patients adopted the aid they normally used for walking; oxygen consumption was the same in the two tests. Therefore, for both transtibial and transfemoral patients, ECW was greater during walking on the treadmill. Steady-state heart rate did not differ in the two tests. The data show that the ECW values of the amputated subjects obtained on the treadmill at the end of rehabilitation did not correspond with those they obtained on the floor. The floor test is the one that may better reflect walking with prostheses and aids in everyday life, in subjects with dysvascular lower limb amputation, using the prosthesis for a short time.
Asunto(s)
Amputación Quirúrgica , Metabolismo Energético/fisiología , Prueba de Esfuerzo , Pisos y Cubiertas de Piso , Extremidad Inferior/cirugía , Caminata/fisiología , Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Aterosclerosis/cirugía , Gasto Cardíaco/fisiología , Angiopatías Diabéticas/cirugía , Femenino , Fémur/cirugía , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Enfermedades Vasculares Periféricas/cirugía , Intercambio Gaseoso Pulmonar/fisiología , Respiración , Tibia/cirugíaRESUMEN
OBJECTIVES: To evaluate the functional status of people with transfemoral amputation and hemiparesis and to identify the factors that influence rehabilitation outcome after inpatient treatment. DESIGN: Retrospective study. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-five patients (30 men, 15 women; mean age, 69+/-9y) with intact mental status affected by unilateral transfemoral amputation for vascular disease and mild or moderate hemiparesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Barthel Index effectiveness, and Locomotor Capabilities Index (LCI) scores were measured. The following factors were studied: side and cause of amputation, side and severity of hemiparesis, sequence and laterality of dual impairment, time interval between impairments, and hospital length of stay. RESULTS: At discharge, mean Barthel Index and LCI scores +/-1 standard deviation were 79+/-12 and 15+/-5.6, respectively; Barthel Index effectiveness was 55+/-23.8. Only 2 patients ambulated without walking aids. Barthel Index effectiveness was better in patients with mild hemiparesis than in patients with more severe impairment. Ipsilateral localization of dual impairment increased the probability of higher LCI scores. CONCLUSIONS: Selected patients with dual impairment can recover the ability to walk. Severity of hemiparesis and laterality were the 2 clinical factors that had the greatest influence on functional measures.