title: Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities.
abstract: BACKGROUND
  In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities.
  
  
  OBJECTIVE
  The purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking.
  
  
  METHODS
  Thirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b(2) oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO(2) rate (mL/min), VO(2) cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min).
  
  
  RESULTS
  It was observed that VO(2) uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P<0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO(2) uptake rate (P<0.005) and EE/min (P<0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO(2) uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis.
  
  
  CONCLUSIONS
  The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.
authors.affiliation: Master in Prosthetics & Orthotics Training Section, National Institute for the Orthopedically Handicapped, Bon Hooghly, Kolkata, India. rajeshmpo48@gmail.com
authors.forename: R K
authors.initials: RK
authors.lastname: Mohanty
authors.forename: P
authors.initials: P
authors.lastname: Lenka
authors.forename: A
authors.initials: A
authors.lastname: Equebal
authors.forename: R
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D001186:Artificial Limbs; D003446:Crutches; D004734:Energy Metabolism; D005260:Female; D006339:Heart Rate; D006801:Humans; D007866:Leg; D008297:Male; D010101:Oxygen Consumption; D016138:Walking / Q000502:physiology*