Plantar pressures reveal adaptive changes for postural balance in amputees

Plantar pressures reveal adaptive changes for postural balance in amputees

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Title: Plantar pressures reveal adaptive changes for postural balance in amputees
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Article_Title: Plantar pressures reveal adaptive changes for postural balance in amputees
Authors: Gigi Adrian Aiordachioae, Horia Haragus, Dinu Vermesan, Ionut Stoia, Alexandru Pop
Affiliation: ”Vasile Goldis” Western University of Arad
University of Medicine and Pharmacy “Victor Babes” Timisoara
Polytechnic University Timisoara
Abstract: There is a high prevalence of peripheral arterial disease in the general population. A minority of this group will require lower limb amputation with important functional and social consequences. Energy costs of amputees gait severely strains the cardiovascular resources of the amputee. Such findings have led us to aim to improve the mobility and thus decrease cardiovascular output by determining the gait patterns of patients with below the knee amputations due to peripheral arterial disease. 8 patients with below the knee amputations were analyzed using a capacitive platform. They all had healed stumps, patellar tendon supporting cups and simple, articulated ankles and important co-morbidities. The inappropriate forward transmission of inertia is apparent on the ground reaction forces readings. The healthy limb has longer steps, stance, single support and pre-swing loading and a decreased load response; these modifications show inappropriate control and confidence in the prosthetic limb, as well as deficient ankle function during pre-swing and heel strike. Uncertainty of position sense can be seen even when the patient is standing and has visual balance control. We conclude that both postural and gait alterations are clearly identifiable in transtibial amputees using plantar pressure distribution analysis. These measurements can aid with rehabilitation, follow-up progression and prosthetic design.
Keywords: amputee, balance, adaptive changes, gait, plantar pressures
References: Dormandy J, Heeck L, Vig S. Major amputations: clinical patterns and predictors. Semin Vasc Surg. Jun 1999;12(2):154-61
Fernie GR, Holliday PJ: Postural sway in amputees and normal subjects. J Bone Joint Surg Am 1978, 60:895-8.
Guzman RJ, Brinkley DM, Schumacher PM, Donahue RM, Beavers H, Qin X. Tibial artery calcification as a marker of amputation risk in patients with peripheral arterial disease. J Am Coll Cardiol. 2008 May 20;51(20):1967-74.
Hlavackova P, Franco C, Diot B, Vuillerme N. Contribution of each leg to the control of unperturbed bipedal stance in lower limb amputees: new insights using entropy. PLoS One. 2011;6(5):e19661.
Hofstad C, Linde H, Limbeek J, Postema K. Prescription of prosthetic ankle-foot mechanisms after lower limb amputation. Cochrane Database Syst Rev. 2004;(1):CD003978
Johannesson A, Larsson GU, Ramstrand N, Turkiewicz A, Wiréhn AB, Atroshi I. Incidence of lower-limb amputation in the diabetic and nondiabetic general population: a 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations. Diabetes Care. 2009 Feb;32(2):275-80.
Mayer et al.: Adaptation to altered balance conditions in unilateral amputees due to atherosclerosis: a randomized controlled study. BMC Musculoskeletal Disorders 2011 12:118.
McNealy LL, Gard SA. Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations. Prosthet Orthot Int. Mar 2008;32(1):111-26
Nadollek H, Brauer S, Isles R. Outcomes after trans-tibial amputation: the relationship between quiet stance ability, strength of hip abductor muscles and gait. Physiother Res Int. 2002;7(4):203-14.
Sagawa Y Jr, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture. 2011 Apr;33(4):511-26.
Selles R, Bussmann J, Van Soest AJ, Stam H. The effect of prosthetic mass properties on the gait of transtibial amputees–a mathematical model. Disabil Rehabil. Jun 17 2004;26(12):694-704
Skinner HB, Effeney DJ. Gait analysis in amputees. Am J Phys Med. 1985 Apr;64(2):82-9.
Tokuno CD, Sanderson DJ, Inglis JT, Chua R. Postural and movement adaptations by individuals with a unilateral below-knee amputation during gait initiation. Gait Posture. Dec 2003;18(3):158-69.
Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JP, Hof AL, Postema K. Gait termination in lower limb amputees. Gait Posture. 2008a;27(1):82-90.
Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JP, Hof AL, Postema K. Gait initiation in lower limb amputees. Gait Posture. 2008b;27(3):423-30.
Read_full_article: pdf/23-2013/23-2-2013/SU23-2-2013-Aiordachioae2.pdf
Correspondence: Aiordachioaie Gigi Adrian, “Vasile Goldiş” Western University Arad, Faculty of Medicine, Department of Semiologie chirurgicala, Piata Mihai Viteazu Nr. 7-8., 310017, Arad, Romania, Tel. +40-(722166895), email: gigi_aiordachioaie@yahoo.com

Read full article
Article Title: Plantar pressures reveal adaptive changes for postural balance in amputees
Authors: Gigi Adrian Aiordachioae, Horia Haragus, Dinu Vermesan, Ionut Stoia, Alexandru Pop
Affiliation: ”Vasile Goldis” Western University of Arad
University of Medicine and Pharmacy “Victor Babes” Timisoara
Polytechnic University Timisoara
Abstract: There is a high prevalence of peripheral arterial disease in the general population. A minority of this group will require lower limb amputation with important functional and social consequences. Energy costs of amputees gait severely strains the cardiovascular resources of the amputee. Such findings have led us to aim to improve the mobility and thus decrease cardiovascular output by determining the gait patterns of patients with below the knee amputations due to peripheral arterial disease. 8 patients with below the knee amputations were analyzed using a capacitive platform. They all had healed stumps, patellar tendon supporting cups and simple, articulated ankles and important co-morbidities. The inappropriate forward transmission of inertia is apparent on the ground reaction forces readings. The healthy limb has longer steps, stance, single support and pre-swing loading and a decreased load response; these modifications show inappropriate control and confidence in the prosthetic limb, as well as deficient ankle function during pre-swing and heel strike. Uncertainty of position sense can be seen even when the patient is standing and has visual balance control. We conclude that both postural and gait alterations are clearly identifiable in transtibial amputees using plantar pressure distribution analysis. These measurements can aid with rehabilitation, follow-up progression and prosthetic design.
Keywords: amputee, balance, adaptive changes, gait, plantar pressures
References: Dormandy J, Heeck L, Vig S. Major amputations: clinical patterns and predictors. Semin Vasc Surg. Jun 1999;12(2):154-61
Fernie GR, Holliday PJ: Postural sway in amputees and normal subjects. J Bone Joint Surg Am 1978, 60:895-8.
Guzman RJ, Brinkley DM, Schumacher PM, Donahue RM, Beavers H, Qin X. Tibial artery calcification as a marker of amputation risk in patients with peripheral arterial disease. J Am Coll Cardiol. 2008 May 20;51(20):1967-74.
Hlavackova P, Franco C, Diot B, Vuillerme N. Contribution of each leg to the control of unperturbed bipedal stance in lower limb amputees: new insights using entropy. PLoS One. 2011;6(5):e19661.
Hofstad C, Linde H, Limbeek J, Postema K. Prescription of prosthetic ankle-foot mechanisms after lower limb amputation. Cochrane Database Syst Rev. 2004;(1):CD003978
Johannesson A, Larsson GU, Ramstrand N, Turkiewicz A, Wiréhn AB, Atroshi I. Incidence of lower-limb amputation in the diabetic and nondiabetic general population: a 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations. Diabetes Care. 2009 Feb;32(2):275-80.
Mayer et al.: Adaptation to altered balance conditions in unilateral amputees due to atherosclerosis: a randomized controlled study. BMC Musculoskeletal Disorders 2011 12:118.
McNealy LL, Gard SA. Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations. Prosthet Orthot Int. Mar 2008;32(1):111-26
Nadollek H, Brauer S, Isles R. Outcomes after trans-tibial amputation: the relationship between quiet stance ability, strength of hip abductor muscles and gait. Physiother Res Int. 2002;7(4):203-14.
Sagawa Y Jr, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture. 2011 Apr;33(4):511-26.
Selles R, Bussmann J, Van Soest AJ, Stam H. The effect of prosthetic mass properties on the gait of transtibial amputees–a mathematical model. Disabil Rehabil. Jun 17 2004;26(12):694-704
Skinner HB, Effeney DJ. Gait analysis in amputees. Am J Phys Med. 1985 Apr;64(2):82-9.
Tokuno CD, Sanderson DJ, Inglis JT, Chua R. Postural and movement adaptations by individuals with a unilateral below-knee amputation during gait initiation. Gait Posture. Dec 2003;18(3):158-69.
Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JP, Hof AL, Postema K. Gait termination in lower limb amputees. Gait Posture. 2008a;27(1):82-90.
Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JP, Hof AL, Postema K. Gait initiation in lower limb amputees. Gait Posture. 2008b;27(3):423-30.
*Correspondence: Aiordachioaie Gigi Adrian, “Vasile Goldiş” Western University Arad, Faculty of Medicine, Department of Semiologie chirurgicala, Piata Mihai Viteazu Nr. 7-8., 310017, Arad, Romania, Tel. +40-(722166895), email: gigi_aiordachioaie@yahoo.com