Original article
Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

https://doi.org/10.1016/j.apmr.2010.07.014Get rights and content

Abstract

Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.

Objective

To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.

Design

Intervention study with crossover design.

Setting

University research center.

Participants

Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.

Intervention

Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).

Main Outcome Measures

Physical function, gait, dynamic balance.

Results

The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.

Conclusions

Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.

Section snippets

Participants

Men (N=5; age, 58.8±11.9y; stature, 175.2±4.9m; mass, 78.2±8.0kg; amputation duration, 31.8±17.3y; range, 5–49y) with unilateral transfemoral amputations of medium/long residual limb length10 and stable residual limb volumes participated in this investigation. Participants were recruited from hospital outpatient records and through an advertisement in a local amputee support group (Limbs4life) newsletter (Amplified). All participants met the following criteria for inclusion in the study: (1)

Functional Tests

No significant functional test differences were found (table 2). Although not significant, performance improved with the 3R92. Compared with the 3R90 and original device, performance with the 3R92 on the 6-Minute Walk Test increased by 17m and improved by 1.1 and 0.6s for the FSST and TUG, respectively.

Prosthesis Evaluation Questionnaire

The total group PEQ score for the 3R92 was higher than for the 3R90, but similar to the original device (see table 2). However, participant 2 scored 79.6 (original device), 92.8 (3R90), and 85.1

Discussion

This study investigated the effect of a new generation of mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance of a group of transfemoral amputees. Specifically, physical function was assessed by using the TUG, 6-Minute Walk Test, and FSST, whereas gait was assessed across flat ground and under conditions requiring a sudden turn or stop.

Method limitations of this study include the small sample size, different prosthetic devices used by participants on

Conclusions

Although not significant, differences were found between prosthetic knee joints. Physical function improved with the 3R92. The 3R90 gained the lowest rating on the PEQ. Overall, sudden-turn success rates were higher for the original device, with the crossover strategy the most difficult (least successful) to implement. Gait and symmetry measures were unchanged across prostheses. This finding is important because it shows that gait was unaffected, although gait training was provided with an

References (20)

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Supported by the Austin Hospital Medical Research Foundation, Austin Health, Melbourne, Victoria, Australia, Project No 02866.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

Reprints are not available from the author.

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