title: Temporal Spatial and Metabolic Measures of Walking in Highly Functional Individuals With Lower Limb Amputations.
abstract: To record the temporal spatial parameters and metabolic energy expenditure during walking of individuals with amputation, walking with advanced prostheses, and after completion of comprehensive rehabilitation compared with able-bodied persons.
  
  
  
  Cross-sectional.
  
  
  
  Multidisciplinary comprehensive rehabilitation center.
  
  
  
  Severely injured UK military personnel with amputation and subsequent completion of their rehabilitation program (n=30; unilateral transtibial: n=10, unilateral transfemoral: n=10, and bilateral transfemoral: n=10) were compared with able-bodied persons (n=10) with similar age, height, and mass (P>.537). Total number of participants (N = 40).
  
  
  
  Not applicable.
  
  
  
  Temporal spatial and metabolic energy expenditure data were captured during walking on level ground at a self-selected speed.
  
  
  
  The individuals with amputation were all men, with a mean age of 29±4 years and a mean New Injury Severity Score of 31±16. Walking speed, stride length, step length, and cadence of individuals with a unilateral transtibial or transfemoral amputation were comparable with able-bodied persons, and only individuals with a bilateral transfemoral amputation had a significantly slower walking speed (1.12m/s, P=.025) and reduced cadence (96 steps per minute, P=.026). Oxygen cost for individuals with a unilateral transtibial amputation (0.15mL/kg/m) was the same as for able-bodied persons (0.15mL/kg/m) and significantly increased by 20% (0.18mL/kg/m, P=.023) for unilateral transfemoral amputation and by 60% (0.24mL/kg/m, P<.001) for bilateral transfemoral individuals with amputation.
  
  
  
  The scientific literature reports a wide range of gait and metabolic energy expenditure across individuals with amputation. The results of this study indicate that individuals with amputation have a gait pattern which is highly functional and efficient. This is comparable with a small number of studies reporting similar outcomes for individuals with a unilateral transtibial amputation, but the results from this study are better than those on individuals with transfemoral amputations reported elsewhere, despite comparison with populations wearing similar prosthetic componentry. Those studies that do report similar outcomes have included individuals who have been provided with a comprehensive rehabilitation program. This suggests that such a program may be as important as, or even more important than, prosthetic component selection in improving metabolic energy expenditure. The data are made available as a benchmark for what is achievable in the rehabilitation of some individuals with amputations, but agreeably may not be possible for all amputees to achieve.
authors.affiliation: Department of Exercise and Sport Science, Manchester Metropolitan University, Manchester, UK; School of Health Sciences, University of Salford, Salford, UK. Electronic address: h.l.jarvis@salford.ac.uk.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Jarvis
authors.affiliation: Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Surrey, UK; United National Institute for Prosthetics and Orthotics Development, University of Salford, Salford, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Alex N
authors.initials: AN
authors.lastname: Bennett
authors.affiliation: School of Health Sciences, University of Salford, Salford, UK; United National Institute for Prosthetics and Orthotics Development, University of Salford, Salford, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Twiste
authors.affiliation: Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Surrey, UK.
authors.forename: Rhodri D
authors.initials: RD
authors.lastname: Phillip
authors.affiliation: Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Surrey, UK.
authors.forename: John
authors.initials: J
authors.lastname: Etherington
authors.affiliation: Department of Exercise and Sport Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D003430:Cross-Sectional Studies; D004734:Energy Metabolism / Q000502:physiology*; D005080:Exercise Test; D006801:Humans; D015601:Injury Severity Score; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008889:Military Personnel; D012047:Rehabilitation Centers; D013997:Time Factors; D006113:United Kingdom; D016138:Walking / Q000502:physiology*; D000072797:Walking Speed
keywords: Amputation; Gait; Rehabilitation