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Energy transfer mechanisms as a compensatory strategy in below knee amputee runners.

Below knee amputee runners exhibit abnormalities in the mechanical work characteristics of the lower extremity musculature during stance phase. The most significant abnormality is a marked reduction in the mechanical work done in the stance phase prosthetic limb. Energy transfer across the hip joint to the trunk during deceleration of the swing phase leg may be an important energy distribution mechanism to compensate for the reduced work done during prosthetic stance phase. Five unilateral below knee amputee runners wearing the SACH prosthetic foot and 5 normal subjects were studied. All subjects ran at a controlled velocity of 2.8 ms(-1) while kinematic and ground reaction force data were collected. Using a four segment linked segment model and an inverse dynamics approach joint moments, muscle power outputs, mechanical work values and energy transfers across the hip were calculated. The total amount of energy transferred during swing phase and the energy transferred out of the swing phase leg into the trunk were both significantly greater than normal. Energy transfer mechanisms are important in influencing the lower extremity energetics during swing phase. In addition, the 74 percent increase in energy transfer out of the intact swing phase limb combined with the temporal characteristics of this energy flow suggests that energy transfer may be an adaptive mechanism that allows energy redistribution to the trunk which may partially compensate for the reduced power output of the stance phase prosthetic limb.

Adaptation, Physiological↗

Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components.

In this study, the influence of different prosthetic alignments and components on oxygen consumption and the important biomechanical characteristics of the normal gait pattern of leg amputees was investigated. With 15 transtibial and 12 transfemoral amputees, the oxygen consumption during walking on a treadmill was analyzed and biomechanical parameters during walking on even ground at a self-selected speed were defined. The amputation of all patients was caused by trauma. Variations of the prosthetic alignment affect the energy consumption of transfemoral amputees more significantly than that of transtibial amputees. Comparison of different prosthetic feet worn by transtibial amputees did not show significant differences regarding metabolic parameters. Compared with conventional hydraulic knee controls, the oxygen consumption of transfemoral amputees provided with an electronically controlled hydraulic knee joint is reduced. All investigated variations can be clearly characterized by the sagittal moments acting on the joints of the prosthetic limb during gait.

Adolescent↗

Elbow joint, crutches and locomotion: special reference to persons with haemophilia.

A 52-year-old, trans-femoral amputee with haemophilia was hospitalized because of ambulatory problems arising from the osteo-arthropathic involvement of other major articulations. Reduced function in the upper limbs, caused by the effects of recurrent haemarthroses, resulted in additional problems concerning the usage of auxiliary ambulatory aids. The advantages and disadvantages of traditional and experimental crutches highlight the functional problems of ambulation in persons with concomitant upper limb pathologies.

Amputees↗

Effect of prosthetic mass on swing phase work during above-knee amputee ambulation.

Recent advances in prosthetic technology have resulted in prosthetic limbs that weigh substantially less than those previously used by amputees. Although one of the clinical expectations associated with lighter limbs was that they would reduce the abnormally high metabolic cost of amputee ambulation, this has not be shown in oxygen consumption studies. This expectation was based on previous studies of normal walking, which showed that the greatest changes in mechanical work occurs in the leg during swing phase acceleration and deceleration. To better understand the relationship between limb mass and mechanical work, this study assessed the effect of varying prosthetic limb masses on the sources and magnitude of the mechanical work required for limb movement during swing. Eight above-knee amputees were studied during over ground walking at their self-selected speeds while wearing identical prosthetic limbs under three weight conditions: unweighted; 0.68 kg of added mass; 1.34 kg of added mass. Using inverse dynamics, the mechanical work from muscle sources and joint transfer sources that was used to accelerate the limb forward during late stance and early swing was determined and compared with the recovery of energy from the limb by hip joint transfer to the trunk during terminal swing deceleration. With the addition of 1.34 kg of mass, there was a combined increase in hip flexor muscle concentric work and mechanical energy transfer across the hip joint of 5.4 J, which was needed to accelerate the heavier prosthetic limb into the swing phase. The increase in acceleration work was balanced by a comparable increase (5.6 J) in the recovery of leg energy during terminal swing deceleration. By effectively conserving the additional mechanical work needed to propel a heavier limb, amputees appear to minimize any adverse effect of prosthetic mass on the mechanical work of walking. This may explain the absence of differences in metabolic cost between limbs of different masses.

Adult↗

The care of the limb deficient child in Australia.

The incidence of limb deficiency is given as is the prevalence of prosthetic use in Australia. The organisation of clinics and the Free Limb Scheme is described and its effects discussed.

Artificial Limbs↗

Congenital deficiency of the femur.

A classification system for congenital deficiency of the femur is introduced, based on initial radiographic appearance of the hip joint in 60 patients (70 affected limbs). Follow-up records ranging from 1 to 30 years demonstrated a relatively constant percentage of shortening in each patient with further growth (2.4% average change). Treatment programs have been established for each of the following groups: I, short femur with good hip joint (19 limbs); II, short femur and coxa vara (17 limbs); III, short femur with proximal deficiency, a well-developed hip joint, and broad angulated and sclerosed diaphysis (15 limbs); IV, dysplastic distal femoral segment with no hip joint (16 limbs); and V, total absence of the femur (3 limbs).

Acetabulum↗