Journal of Research in Rehabilitation Sciences

Asymmetry in Stance Time during Gait in Lower Limb Amputees Using Prosthesis: A Systematic Review and Meta-Analysis

Document Type : Review Articles

Authors

1 PhD Student, Department of Biomedical Engineering, School of New Technologies, University of Semnan, Semnan, Iran

2 Assistant Professor, Department of Biomedical Engineering, School of New Technologies, University of Semnan, Semnan, Iran

10.22122/jrrs.v14i1.3061

Abstract

Introduction: The gait has an approximately symmetric pattern which comprises two general phases, stance and swing. Using lower limb prosthesis alters this symmetry. In order to achieve quantitative results, and integrate the results of various researches, this systematic review and meta-analysis of stance time of the gait cycle was carried out. These quantitative results can be a proper tool for the optimal design of prostheses, and reliable prescribing for prosthesis according to physical features of amputees.Materials and Methods: Searching related keywords in valid databases of ScinceDirect, PubMed and IEEE, the researcher found 98 studies out of 1350 investigations carried out between 2007 and 2018, all of which were in line with the systematic review procedures. Finally, due to the qualitative evaluation of selected papers, 15 experimental studies meeting the required criteria were included in the present meta-analysis for further processes of calculation and interpretation of the reasonable effect size.Results: The stance time with the residual limb is 4.07 percent shorter than the intact limb. Moreover, the control group had less stance phase of 1.65 percent in comparison with the prosthesis limb. Finally, it was found that the intact limb had approximately 1.84 percent longer stance time than the control group.Conclusion: According to qualitative results of the present meta-analysis, asymmetry of stance time for amputees in contrast to the control group would be beneficial for evaluating the prosthesis design, improving neuromuscular studies in rehabilitation field, and compensating the walking asymmetry caused by movement problems in prolonged use of prosthesis.

Keywords

  1. Brach JS, Studenski S, Perera S, VanSwearingen JM, Newman AB. Stance time and step width variability have unique contributing impairments in older persons. Gait Posture 2008; 27(3): 431-9.
  2. Soares AS, Yamaguti EY, Mochizuki L, Amadio AC, Serrao JC. Biomechanical parameters of gait among transtibial amputees: A review. Sao Paulo Med J 2009; 127(5): 302-9.
  3. Prinsen EC, Nederhand MJ, Rietman JS. Adaptation strategies of the lower extremities of patients with a transtibial or transfemoral amputation during level walking: A systematic review. Arch Phys Med Rehabil 2011; 92(8): 1311-25.
  4. Wentink EC, Prinsen EC, Rietman JS, Veltink PH. Comparison of muscle activity patterns of transfemoral amputees and control subjects during walking. J Neuroeng Rehabil 2013; 10: 87.
  5. Sturk JA, Lemaire ED, Sinitski EH, Dudek NL, Besemann M, Hebert JS, et al. Maintaining stable transfemoral amputee gait on level, sloped and simulated uneven conditions in a virtual environment. Disabil Rehabil Assist Technol 2017; 1-10. [Epub ahead of print].
  6. Grumillier C, Martinet N, Paysant J, Andre JM, Beyaert C. Compensatory mechanism involving the hip joint of the intact limb during gait in unilateral trans-tibial amputees. J Biomech 2008; 41(14): 2926-31.
  7. Smith DG, Michael JW, Bowker JH. Atlas of amputations and limb deficiencies: surgical, prosthetic, and rehabilitation principles. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004.
  8. Devan H, Carman A, Hendrick P, Hale L, Ribeiro DC. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review. J Rehabil Res Dev 2015; 52(1): 1-19.
  9. Kamali M, Sharif-Moradi K, Tahmasebi A, Jabal-Ameli K. Effect of below knee prosthesis on muscle force production and joint contact forces of knee and hip joints during walking in amputees. Iran J War Public Health 2017; 9(2): 79-84. [In Persian].
  10. Bae TS, Choi K, Hong D, Mun M. Dynamic analysis of above-knee amputee gait. Clin Biomech (Bristol, Avon) 2007; 22(5): 557-66.
  11. Su PF, Gard SA, Lipschutz RD, Kuiken TA. Gait characteristics of persons with bilateral transtibial amputations. J Rehabil Res Dev 2007; 44(4): 491-501.
  12. Centomo H, Amarantini D, Martin L, Prince F. Muscle adaptation patterns of children with a trans-tibial amputation during walking. Clin Biomech (Bristol, Avon) 2007; 22(4): 457-63.
  13. Goujon-Pillet H, Sapin E, Fode P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait. Arch Phys Med Rehabil 2008; 89(1): 87-94.
  14. Kovac I, Medved V, Ostojic L. Spatial, temporal and kinematic characteristics of traumatic transtibial amputees' gait. Coll Antropol 2010; 34(Suppl 1): 205-13.
  15. Hendershot BD, Wolf EJ. Three-dimensional joint reaction forces and moments at the low back during over-ground walking in persons with unilateral lower-extremity amputation. Clin Biomech (Bristol, Avon) 2014; 29(3): 235-42.
  16. Sinitski EH, Lemaire ED, Baddour N, Besemann M, Dudek NL, Hebert JS. Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment. Gait Posture 2015; 41(2): 568-73.
  17. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52(6): 377-84.
  18. Pantall A, Ewins D. Muscle activity during stance phase of walking: comparison of males with transfemoral amputation with osseointegrated fixations to nondisabled male volunteers. J Rehabil Res Dev 2013; 50(4): 499-514.
  19. Parker K, Hanada E, Adderson J. Gait variability and regularity of people with transtibial amputations. Gait Posture 2013; 37(2): 269-73.
  20. Hekmatfard M, Farahmand F, Ebrahimi I. Effects of prosthetic mass distribution on the spatiotemporal characteristics and knee kinematics of transfemoral amputee locomotion. Gait Posture 2013; 37(1): 78-81.
  21. Kendell C, Lemaire ED, Kofman J, Dudek N. Gait adaptations of transfemoral prosthesis users across multiple walking tasks. Prosthet Orthot Int 2016; 40(1): 89-95.
  22. Ingraham KA, Fey NP, Simon AM, Hargrove LJ. Assessing the relative contributions of active ankle and knee assistance to the walking mechanics of transfemoral amputees using a powered prosthesis. PLoS One 2016; 11(1): e0147661.
  23. Kendall MG, Stuart A, Ord K. Kendall's advanced theory of statistics. Hoboken, NJ: Wiley; 2010.
  24. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010; 1(2): 97-111.
  25. 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; 33(4): 511-26.
  26. Kendell C, Lemaire ED, Dudek NL, Kofman J. Indicators of dynamic stability in transtibial prosthesis users. Gait Posture 2010; 31(3): 375-9.
  27. Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: A systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon) 2013; 28(8): 831-45.
  28. Powers CM, Rao S, Perry J. Knee kinetics in trans-tibial amputee gait. Gait Posture 1998; 8(1): 1-7.
Journal of Research in Rehabilitation Sciences
Volume 14, Issue 1 - Serial Number 1
March 2018
Pages 59-65