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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Study on
Gait Efficiency and Energy Cost of Below Knee Amputees
After Therapeutic Practices |
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Durbadal Biswas, JRF, National
Institute for the Orthopaedically Handicapped, Under Ministry of Social
Justice and Empowerment, Govt. of India, B-T Road, Bon Hooghly, Kolkata-700090,
Lenka PK, Lecturer (P and O), National
Institute for the Orthopaedically Handicapped, Under Ministry of Social
Justice and Empowerment, Govt. of India, B-T Road, Bon Hooghly, Kolkata-700090,
Sukumar Roy,
Head, Dept. of Biomedical Engineering, Dept. NSEC, Garia,
Ratnesh Kumar Director, National
Institute for the Orthopaedically Handicapped, Under Ministry of Social
Justice and Empowerment, Govt. of India, B-T Road, Bon Hooghly, Kolkata-700090. |
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Address for Correspondence |
Department of Research and
Development,
National Institute for the
Orthopaedically Handicapped,
Under Ministry of Social Justice
and Empowerment, Govt. of India,
B.T. Road, Bon Hooghly,
Kolkata-90,
India.
E-mail:
durbadal.bme@gmail.com |
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Biswas D, Lenka PK, Roy S, Kumar R. Study on
Gait Efficiency and Energy Cost of Below Knee Amputees
After Therapeutic Practices. Online J Health Allied Scs.
2011;10(1):14 |
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Submitted: Dec 29,
2010; Accepted: Jan 10, 2011; Published: April 15, 2011 |
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| Abstract: |
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An earlier
research advocated that a below knee amputee (BK) with conventional
trans-tibial prosthesis attains higher gait efficiency at lower energy
cost with therapeutic practices of proper time and co-ordination in
compare to normal subjects of similar physical parameters and quality
of life. The present study focused on comparative analysis of energy
cost and gait efficiency between a group of below knee amputees and
a control group (normal subjects without amputation) to indicate the
consistency of the earlier findings. The subjects were selected with
similar physical parameters and quality of life. Oxygen Uptake (VO2)
and Heart Rate (HR) were measured by Cosmed® k4 b2 analyzer
system. Gait efficiency (p < 0.0001) was found higher with lower
energy cost for BK amputees after therapeutic practices than control
group. The therapeutic activities contributed to efficient gait pattern
for amputees ensuring proper time and co-ordination with balance in
consistence to the earlier research.
Key Words:
Energy Cost; Gait Efficiency; Below knee amputee
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A previous
research showed that appropriate time and co-ordination of movement
resulted in confident gait rhythm and balance with less energy cost
for the below knee amputees.(1) Biswas D et al advocated that proper
training for time and co-ordination and prescribed therapeutic practice
of movements can help the amputee with below knee prosthesis to achieve
their ideal gait with less energy cost in comparison to the normal subjects
with non-pathological gait with similar physical parameters and quality
of life.(2) It was studied earlier that the lower extremity amputees
need to spend massive effort and time to attain their ideal gait efficiency.
Whereas achieving the efficient locomotion acts a major role in the
individual development.(3) Ambulation is practically difficult for
trans-tibial amputees due to excessive energy cost. Earlier studies
established elevated relation of energy expenditure and decreased gait
efficiency in the transtibial amputees in comparison to the normal subjects
with non-pathological gait.(4-11) Gait efficiency is defined as energy
cost per distance traveled in previous research papers. (9) The lowest
value is considered the Optimum efficiency at the self selected speed.(4,9) Preceding research showed the higher energy consumption in amputees
with leg prosthesis than normal at comparable walking velocities.(12-14) Ganguly et al determined 33% more energy cost for transtibial amputees
than the normal subjects at 50 m/min walking speed.(5) Conversely,
most of lower limb amputees can attain their normal gait within their
limitation of disabilities with the practice of proper time and co-ordination.
The purpose of this study was to compare the energy cost, gait efficiency
of a group of physically active below knee amputees with conventional
trans-tibial prosthesis after therapeutic practices versus a group of
normal person with similar physical parameters (sex, age, height, and
weight) and quality of life during their normal locomotion.
Fifteen Trans-tibial
amputees with conventional prosthesis having patella-tendon-bearing
(PTB) socket and a solid-ankle-cushion-heel (SACH) foot for more than
3 years were selected in this study with their consent to the National
Institute for the Orthopaedically Handicapped, Bon-hooghly, Kolkata-90,
India. The amputees were at ease with the prosthesis and did not suffer
from residual limb pain, swelling, or pressure sores. The fitting and
alignment of the prosthesis was examined by the resident Department
of Prosthetics and Orthotics of the institute. A control group was also
selected with 30 normal subjects with non pathological gait and similar
physical parameters. (Table 1) All the subjects were examined physically
active and well balanced according to the protocol. They were instructed
not to ingest alcohol or caffeine for 24 hours prior to the study. Subjects’
diet was recorded and similar diet was maintained.
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Table 1: Physical
Parameters of the subjects |
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Criteria |
BK Amputees |
Control Group |
| Age (yrs.) |
44.1±5.9 |
43±6 |
| Height (cm.) |
159±16.5 |
162±14.5 |
| Weight (kgs.) |
56.5±9.2 |
59.6±7.3 |
The subjects’
Quality Of Life was studied with WHOQOL-100 quality of life assessment.
The assessment would be applicable cross-culturally.(15) In this study
the assessment determined the similar Quality of life for both subjects.
(Table 2)
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Table 2: Quality of Life
Assessment |
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Domain |
Average
Scores |
| Below
Knee Amputees |
Control Group |
| Physical
health |
23.97 |
24.98 |
| Psychological |
19.01 |
18.90 |
| Social
relationship |
10 |
11 |
| Environment |
27.18 |
27.22 |
The subjects
were guided to practice their usual gait prior to the testing until
the normal gait pattern was observed. The gait of the amputees was closely
observed and they were guided to attain optimum walking rhythm &
balance in their usual locomotion through therapeutic practices. The
amputees were trained by to improve the mobility to ensure the optimum
time and co-ordination of movements. A plane surface of 30 m was fixed
for subjects’ walking in their usual gait. The subjects were asked
to walk at self selected speed. At this time, breath by breath analysis
of the subjects was carried out. A Cosmed® k4 b2 Respiratory
Analyzer system (COSMED Srl – Italy) at National Institute for the
Orthopaedically Handicapped, Bon-hooghly, Kolkata-90, India was used
for the measurement of Oxygen Uptake (VO2), Heart Rate (HR)
for all subjects. (Figure 1)
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Figure 1: Cosmed® K4 B2 Respiratory Analyzer system |
The subjects were given adequate time to
get accustomed to the analyzer system before the test. The recorded
data of the subjects’ average VO2 (ml/Min) over consecutive
60 seconds interval were processed by calculating the mean and standard
deviation. Total test time was approximately 30 minutes consisting of
a 3 minute warm-up period to determine that the muscles did not utilize
anaerobic sources of energy, 1 minute to prime the airways, and 1 minute
of exhaled gas collection. The order of experiment protocol was followed
accordingly, and all information of the test was consecutively recorded
at each condition. Subjects were allowed to take rest in the intervals
to minimize the fatigue. Difference in VO2 was determined for walking
period of the subjects as follows:
| Difference
in VO2 = |
VO2 BK
amputee-VO2 normal |
x 100 |
(Equation-1) |
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VO2 normal |
Thus a negative
percentage indicates energy saving and positive percentage indicates
higher energy cost for the subject with BK amputee. (2,16)
Distance Efficiency
is an easily determined alternative criterion measure of Gait Efficiency.
Gait (distance) efficiency was calculated from the ratio of the oxygen
uptake to the walking velocity and may be expressed in milliliters of
oxygen consumed per kilogram of body weight per meter traveled.(2,9)
| Gait
Efficiency= |
mlO2
/kg.min |
=mlO2
/kg.min |
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m/min |
In this study,
two-way analysis of variance (ANOVA) was used separately to test the
level of significance of VO2, HR, EE, velocity and gait efficiency
and a level of p < 0.05 was adopted for the determination
of statistical significance.
A summary of
the result is given in Table 3. Average Heart rate for BK amputees and
control group was 95.03 ± 17.15 beats/min (p < 0.001) and
83.67 ± 9.86 beats/min(p < 0.002) respectively. The velocity of
the BK amputee and control group was 17.90 ± 1.95 m/min and 27.56 ±
4.55 m/min respectively. Gait efficiency (p < 0.0001) is higher for
the BK amputee (0.51 ± 0.12 mlO2
/ kg. m) than control group (0.29 ± 0.21 mlO2
/ kg. m). The difference in VO2 uptake
for the amputee was -7.35%.
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Table 3: Average
values of parameters.
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Parameter |
BK Amputees |
Control Group |
| VO2
(ml/mint) |
448.65
± 123.01 |
484.25±90.06 |
| HR
(beats/mint) |
95.03
±17.15 |
83.67±9.86 |
| Velocity
(m/mint) |
17.90±1.95 |
27.56±4.55 |
| Gait
Efficiency (mlO2 /
kg . m) |
0.51±0.12 |
0.29±0.21 |
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Graph 1: Comparison of Oxygen
Uptake |
Graph 2: Comparison of Gait Efficiency |
Previous research
showed that appropriate time and co-ordination of movement resulted
in confident gait rhythm and balance with less energy cost for the below
knee amputee.(1,2) The current study was performed to compare the
Energy Cost and Gait Efficiency between a group of below knee amputees
with conventional trans-tibial prosthesis and a control group of normal
subjects with non-pathological gait, having the similar physical parameters
and quality of life. Similar physical parameters allowed the subjects
to be considered for comparison analysis. Both the subjects were determined
to lead similar Quality of Life. This nullified any effect of the subjects’
life style on their comparative performances. Thus the only difference
between the subjects was due to the trans-tibial prosthesis of the below
knee amputees. The subjects were certified to be physically fit. The
fitment and alignment of the prosthesis was checked and found perfect.
The recorded data showed consistency in heart rate monitoring for all
the subjects. The subjects performed their normal gait during the test
in their self selected velocity. The gait study advocated the usual
gait pattern in all subjects throughout the test. The difference in
VO2 uptake was -7.35% (p < 0.002). (Equation-1)
The negative percentage determined energy saving for the BK amputee.
The Gait efficiency was found (p < 0.0001) higher for the below knee
amputees (0.51 ± 0.12 mlO2
/ kg. m) than the control group (0.29 ± 0.21 mlO2/kg. m). This result indicated that the below knee
amputees achieved a normal and ideal gait pattern under the limitation
of disabilities. The walking rhythm acted to control the stability and
increase the gait efficiency as the physical parameters were normalized
prior to the experiment by carefully selecting the subjects after screening.
This rhythm contributed to higher gait efficiency for the below knee
amputees ensuring the uniformity of different gait parameters (step
time, step duration, cadence and stride length). The result showed consistency
with the previous published researches that the below knee amputees
attained more efficient gait pattern appropriate for their body mechanics
by therapeutic practices with improved time and co-ordination of movements
ensuring the efficient gait performance with reduced energy cost.(1,2)
The current
study showed consistency with the earlier research. The below knee amputees
with conventional trans-tibial prosthesis attained higher efficiency
in their gait performance with low energy cost in plane surface walking.
The therapeutic activities and walking rhythm contributed to improve
the mobility and balance of below knee amputees. This helped the amputees
to achieve their optimum gait pattern within their limitation of disabilities
ensuring the improved time and co-ordination.
This project
would not have been possible without the participation of the subjects.
Their cooperation, patience, and genuine interest in the progress of
research will be remembered. The research was supported by the Prosthetic
and Orthotic Department of National Institute for the Orthopaedically
Handicapped, Bon-hooghly, Kolkata-90.
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Biswas D,
Roy S, Lenka PK, Kumar R. Energy Cost and Gait
Efficiency of Below-Knee Amputee and Normal Subject with Similar Physical
Parameters and Quality of Life: A Comparative Case Study. Online
J Health Allied Scs. 2010;9(3):14. Available at
http://www.ojhas.org/issue35/2010-3-14.htm
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Department of Exercise and Sport Science, Manchester Metropolitan University,
Stoke-on-Trent, UK.
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