Energy Costs & Performance of Transtibial Amputees & Non-amputees during Walking & Running

Abstract

This study compared energy costs and performance differences of walking and running for transtibial amputee (TTA) and matched non-amputee runners. TTA were tested with 3 prosthetic feet: traditional foot, SACH; general purpose, energy storing and return (ESAR) foot, Renegade; running-specific ESAR foot, Nitro. During walking, VO₂ and gait efficiency (GE) were similar between prosthetic feet. VO₂ was increased (21–33%) and GE was decreased for TTA compared to controls. Self-selected walking speed (SSWS) was slower for SACH (4–6%) compared to Renegade and Nitro but SSWS for TTA was slower (16–22%) than controls. During running, VO₂ was increased (8–18%) and GE was decreased using SACH and Renegade, compared to Nitro. During running, VO₂ was greater (9–38%), GE was decreased and SSRS was slower (17–30%) for TTA, than controls. VO₂ peak was similar for controls and TTA using Nitro, but peak running speed was slower for TTA. In conclusion, during walking energy costs are mostly similar between prosthetic feet, but ESAR feet likely provide faster SSWS for TTA. During running, energy costs and performance are improved for TTA using Nitro. Nonetheless, for all prosthetic feet conditions, TTA demonstrated an energy cost and performance disadvantage during walking and running compared to non-amputee runners.

Key words

carbon fiber prosthetic feet - energy storing and return prosthetic feet - gait efficiency

• References

• 1 Brown MB, Millard-Stafford ML, Allison AR. Running-specific prostheses permit energy cost similar to nonamputees. Med Sci Sports Exerc 2009; 41: 1080-1087
• 2 Buhi ER, Goodson P, Neilands TB. Out of sight, not out of mind: strategies for handling missing data. Am J Health Behav 2008; 32: 83-92
• 3 Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care 2005; 20: 187-191
• 4 Edelstein JE. Prosthetic feet: state of the art. Phys Ther 1988; 68: 1874-1881
• 5 Gailey RS, Wenger MA, Raya M, Kirk N, Erbs K, Spyropoulos P, Nash MS. Energy expenditure of trans-tibial amputees during ambulation at self-selected pace. J Prosthet Orthot 1994; 18: 84-91
• 6 Harriss DJ, Atkinson G. Ethical standards in sports and exercise science research: 2014 update. Int J Sports Med. 2013 34. 1025-1028
• 7 Hartung DM, Touchette D. Overview of clinical research design. Am J Health-Syst Pharm 2009; 66: 398-408
• 8 Hsu M-J, Nielsen DH, Lin-Chan S-J, Shurr D. The effects of prosthetic foot design on physiologic measurements, self-selected walking velocity, and physical activity in people with transtibial amputation. Arch Phys Med Rehabil 2006; 87: 123-129
• 9 Hsu M-J, Nielsen DH, Yack HJ, Shurr DG. Physiological measurements of walking and running in people with transtibial amputations with 3 different prostheses. J Orthop Sports Phys Ther 1999; 29: 526-533
• 10 Hsu M-J, Nielsen DH, Yack J, Shurr DG, Lin S-J. Physiological comparisons of physically active persons with transtibial amputation using static and dynamic prostheses versus persons with nonpathological gait during multiple-speed walking. J Prosthet Orthot 2000; 12: 60-69
• 11 Kang M, Ragan BG, Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train 2008; 43: 215-221
• 12 Kram R, Grabowski AM, McGowan CP, Brown MB, Herr HM. Counterpoint: Artificial legs do not make artificially fast running speeds possible. J Appl Physiol 2010; 108: 1012-1014
• 13 Mann CJ. Observational research methods. Research design II: cohort, cross Sectional, and case-control studies. Emerg Med J 2003; 20: 54-60
• 14 Nielsen DH, Shurr DG, Golden JC, Meier K. Comparison of energy cost and gait efficiency during ambulation in below-knee amputees using different prosthetic feet – a preliminary report. J Prosthet Orthot 1988; 1: 24-31
• 15 Nolan L. Carbon fibre prostheses and running in amputees: a review. Foot Ankle Surg 2008; 14: 125-129
• 16 Noordzij M, Dekker F, Zoccali C, Jager KJ. Study Designs in Clinical Research. Nephron Clin Pract 2009; 113: c218-c221
• 17 Unnebrink K, Windeler J. Intention-to-treat: methods for dealing with missing values in clinical trials of progressively deteriorating diseases. Stat Med 2001; 20: 3931-3946
• 18 Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297
• 19 Waters RL, Mulroy SJ. Energy expenditure of walking in individuals with lower limb amputations. In: Michael JW, Bowker JH, Smith DG. eds Atlas of Amputations and Limb Deficiencies. Surgical, Prosthetic and Rehabilitation Principles. 3^rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004: 395-407
• 20 Weyand PG, Bundle MW. Point: Artificial limbs do make artificially fast running speeds possible. J Appl Physiol 2010; 108: 1011-1012
• 21 Weyand PG, Bundle MW, McGowan CP, Grabowski A, Brown MB, Kram R, Herr H. The fastest runner on artificial legs: different limbs, similar function?. J Appl Physiol 2009; 107: 903-911