Article

OBJECTIVE: To record the temporal spatial parameters and metabolic energy
expenditure during walking of individuals with amputation, walking with advanced
prostheses, and after completion of comprehensive rehabilitation compared with
able-bodied persons.
DESIGN: Cross-sectional. SETTING: Multidisciplinary
comprehensive rehabilitation center. PARTICIPANTS: Severely injured UK military
personnel with amputation and subsequent completion of their rehabilitation
program (n=30; unilateral transtibial: n=10, unilateral transfemoral: n=10, and
bilateral transfemoral: n=10) were compared with able-bodied persons (n=10) with
similar age, height, and mass (P>.537). Total number of participants (N = 40).
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Temporal spatial and
metabolic energy expenditure data were captured during walking on level ground at
a self-selected speed. RESULTS: The individuals with amputation were all men,
with a mean age of 29+/-4 years and a mean New Injury Severity Score of 31+/-16.
Walking speed, stride length, step length, and cadence of individuals with a
unilateral transtibial or transfemoral amputation were comparable with
able-bodied persons, and only individuals with a bilateral transfemoral
amputation had a significantly slower walking speed (1.12m/s, P=.025) and reduced
cadence (96 steps per minute, P=.026). Oxygen cost for individuals with a
unilateral transtibial amputation (0.15mL/kg/m) was the same as for able-bodied
persons (0.15mL/kg/m) and significantly increased by 20% (0.18mL/kg/m, P=.023)
for unilateral transfemoral amputation and by 60% (0.24mL/kg/m, P<.001) for
bilateral transfemoral individuals with amputation. CONCLUSIONS: The scientific
literature reports a wide range of gait and metabolic energy expenditure across
individuals with amputation. The results of this study indicate that individuals
with amputation have a gait pattern which is highly functional and efficient.
This is comparable with a small number of studies reporting similar outcomes for
individuals with a unilateral transtibial amputation, but the results from this
study are better than those on individuals with transfemoral amputations reported
elsewhere, despite comparison with populations wearing similar prosthetic
componentry. Those studies that do report similar outcomes have included
individuals who have been provided with a comprehensive rehabilitation program.
This suggests that such a program may be as important as, or even more important
than, prosthetic component selection in improving metabolic energy expenditure.
The data are made available as a benchmark for what is achievable in the
rehabilitation of some individuals with amputations, but agreeably may not be
possible for all amputees to achieve.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS