Relief of knee flexion contracture and gait improvement following adaptive training for an assist device in a transtibial amputee: A case study

Abstract

BACKGROUND:

Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension.

OBJECTIVE:

This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated.

RESULTS:

Following ATAD, PROM showed immediate improvement (135.6± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved.

CONCLUSIONS:

ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait.

Keywords

Adaptive training for assist device transtibial amputee knee flexion contracture gait ability quality of life

References

Bowker

, Keagy

, Poonekar

. Musculoskeletal complications in amputees: Their prevention and management. Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles 2nd; ed St Louis: Mosby-Year Book. 1992: 665-80.

Bannister

. The Prosthetic Problems of Below Knee Amputees with Flexion Contractures. Australian Journal of Physiotherapy. 1978; 24(1): 21-5.

Gailey

. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. The Journal of Rehabilitation Research and Development. 2008; 45(1): 15-30.

Cerny

, Perry

, Walker

. Adaptations during the stance phase of gait for simulated flexion contractures at the knee. Orthopedics. 1994; 17(6): 501-12; discussion 12-3.

Perry

. Gait analysis. Normal and pathological function. 1992; 1.

Temelli

, Akalan

. Treatment approaches to flexion contractures of the knee. Acta Orthopaedica Et Traumatologica Turcica. 2009; 43(2): 113-20.

Waters

, Mulroy

. The energy expenditure of normal and pathologic gait. Gait & Posture. 1999; 9(3): 207-31.

Potter

, Kirby

, MacLeod

. The effects of simulated knee-flexion contractures on standing balance. American Journal of Physical Medicine & Rehabilitation. 1990; 69(3): 144-7.

Harato

, Nagura

, Matsumoto

, Otani

, Toyama

, Suda

. Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis. The Knee. 2008; 15(6): 467-72.

10.

Harato

, Nagura

, Matsumoto

, Otani

, Toyama

, Suda

. A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome. Gait & Posture. 2008; 28(4): 687-92.

11.

Harato

, Nagura

, Matsumoto

, Otani

, Toyama

, Suda

. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. The Journal of Arthroplasty. 2010; 25(2): 225-9.

12.

Hicks

, Schwartz

, Arnold

, Delp

. Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait. Journal of Biomechanics. 2008; 41(5): 960-7.

13.

Pell

, Donnan

, Fowkes

, Ruckley

. Quality of life following lower limb amputation for peripheral arterial disease. European Journal of Vascular Surgery. 1993; 7(4): 448-51.

14.

Goldberg

. Postoperative management of lower extremity amputations. Physical medicine and rehabilitation clinics of North America. 2006; 17(1): 173-80.

15.

Leimkuehler

. Postoperative Management of the Lower Extremity Amputation. Available from: http: //www.oandp. org/olc/lessons/html/SSC_02/09ampspec.asp?frmCourse SectionId=E4648351-EF8C-4EB4-BB35-8BC07B891B9C.

16.

Kapp

, Cummings

. Transtibial amputation: prosthetic management. Atlas of amputations and limb deficiencies surgical prosthetic and rehabilitation principles American Academy of Orthopaedic Surgeons, Rosemont. 2004; 453-78.

17.

Zidarov

, Swaine

, Gauthier-Gagnon

. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Archives of Physical Medicine and Rehabilitation. 2009; 90(4): 634-45.

18.

Underwood

, Tokuno

, Eng

. A comparison of two prosthetic feet on the multi-joint and multi-plane kinetic gait compensations in individuals with a unilateral trans-tibial amputation. Clinical Biomechanics. 2004; 19(6): 609-16.

19.

Svoboda

, Janura

, Cabell

, Elfmark

. Variability of kinetic variables during gait in unilateral transtibial amputees. Prosthetics and Orthotics International. 2012; 36(2): 225-30.

20.

International Committee of the Red Cross, editor. Exercises For Lower-Limb Amputees - Gait training, 2008.

21.

Gailey

, Roach

, Applegate

, Cho

, Cunniffe

, Licht

, et al. The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate. Archives of Physical Medicine and Rehabilitation. 2002; 83(5): 613-27.

22.

Alter

. Science of flexibility: Human Kinetics Champaign, IL; 1996.

23.

Kalron

, Dvir

, Frid

, Achiron

. Quantifying gait impairment using an instrumented treadmill in people with multiple sclerosis. International Scholarly Research Notices. 2013; 2013.

24.

Henning

HBMOO

, Hennerici

SCM

. Amantadine increases gait steadiness in frontal gait disorder due to subcortical vascular encephalopathy: a double-blind randomized placebo-controlled trial based on quantitative gait analysis. Cerebrovasc Dis. 2001; 11: 235-44.

25.

Nolan

, Wit

, Dudzinski

, Lees

, Lake

, Wychowanski

. Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees. Gait & Posture. 2003; 17(2): 142-51.

26.

Chang

, Bae

, Kim

, Mun

, Lee

. Relationship between ankle inversion angle and knee adduction moment on the intact limb in unilateral transfemoral amputees during walking. International Journal of Precision Engineering and Manufacturing. 2012; 13(4): 609-15.

27.

Segal

, Orendurff

, Czerniecki

, Schoen

, Klute

. Comparison of transtibial amputee and non-amputee biomechanics during a common turning task. Gait & Posture. 2011; 33(1): 41-7.

28.

Brooks

, Parsons

, Hunter

, Devlin

, Walker

. The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation. Archives of Physical Medicine and Rehabilitation. 2001; 82(10): 1478-83.

29.

Gandek

, Ware

. SF-36 Health Survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center. 1993.

30.

Ware

, Kosinski

, Keller

. SF-36 physical and mental health summary scales: a user's manual: Health Assessment Lab. 1994.

31.

Yoshida

, Mizner

, Ramsey

, Snyder-Mackler

. Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clinical Biomechanics. 2008; 23(3): 320-8.

32.

Neugebauer

, Serghiou

, Herndon

, Suman

. Effects of a 12-week rehabilitation program with music & exercise groups on range of motion in young children with severe burns. Journal of burn care & research: official publication of the American Burn Association. 2008; 29(6).

33.

Disseldorp

, Nieuwenhuis

, Van Baar

, Mouton

. Physical fitness in people after burn injury: a systematic review. Archives of Physical Medicine and Rehabilitation. 2011; 92(9): 1501-10.

34.

Chisholm

, Perry

, McIlroy

. Inter-limb centre of pressure symmetry during gait among stroke survivors. Gait & Posture. 2011; 33(2): 238-43.

35.

Schmid

, Beltrami

, Zambarbieri

, Verni

. Centre of pressure displacements in trans-femoral amputees during gait. Gait & Posture. 2005; 21(3): 255-62.

36.

Hillmann

, Rosenbaum

, Winkelmann

. Plantar and dorsal foot loading measurements in patients after rotationplasty. Clinical Biomechanics. 2000; 15(5): 359-64.

37.

Majumdar

, Banerjee

, Majumdar

, Pal

, Kumar

, Selvamurthy

. Temporal spatial parameters of gait with barefoot, bathroom slippers and military boots. Indian Journal of Physiology and Pharmacology. 2006; 50(1): 33.

38.

Hawkins

, Henry

, Crandell

, Nguyen

. A systematic review of functional and quality of life assessment after major lower extremity amputation. Annals of Vascular Surgery. 2014; 28(3): 763-80.

39.

Penn-Barwell

. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury. 2011; 42(12): 1474-9.

40.

Sinha

, van den Heuvel

, Arokiasamy

. Factors affecting quality of life in lower limb amputees. Prosthetics and Orthotics International. 2011; 35(1): 90-6.

41.

Asano

, Rushton

, Miller

, Deathe

. Predictors of quality of life among individuals who have a lower limb amputation. Prosthetics and Orthotics International. 2008; 32(2): 231-43.