Gait re-training, visual feedback do not reduce metabolic demand of walking for transtibial amputees

SAN ANTONIO — The use of real-time visual feedback in a computer-assisted rehabilitation environment did not reduce the metabolic demand of walking for patients with transtibial amputation, according to data presented at the American Orthotic and Prosthetic Association National Assembly.

Elizabeth Russell Esposito, PhD, and colleagues created gait re-training strategies focused on center of mass (COM) sway and thigh muscle activity to see if gait changes would reduce metabolic demand. Esposito, a biomechanics researcher at the Center for the Intrepid at Brooke Army Medical Center, presented the results of the study as one of four presentations included in the awarding-winning Thranhardt Lecture Series, here.

Elizabeth Russell Esposito


Previous research showed that metabolic demand of walking tends to increase following a transtibial amputation. The increased metabolic demand can progress toward a slower gait and ultimately a sedentary lifestyle, Esposito said. Researchers created a gait re-training program with hopes of disrupting the “progressive disablement” that can follow a transtibial amputation. The gait retraining was based on the idea that optimized COM motions lead to better walking economy.

Esposito and colleagues analyzed participants’ COM motions, muscle activity and oxygen consumption while participants underwent gait re-training and received real-time feedback.

“Essentially what we were using in this study was a treadmill with a screen in front of the patients,” Esposito said.

The results showed participants reduced their COM sway by 12.5% and reduced quadriceps activity by 12%. However, the researchers found no difference in metabolic demand compared to controls. Esposito hypothesized the patients may have had little room for improvement in their metabolic demand. She noted all patients wore passive prostheses.

Esposito said other optimization criteria, such as stability, maneuverability and cosmesis, may need to be taken into account. Additionally, she said, co-contraction can be functional.

“Potentially these outcomes are limited to our young, active and otherwise healthy population of service members for whom we care at the Center for the Intrepid. They receive a specialized type of prosthetic care and physical therapy.” – by Amanda Alexander

Reference: Esposito ER. Can individuals with transtibial amputation reduce the metabolic demand of walking using real-time visual feedback? Presented at: American Orthotic and Prosthetic Association National Assembly; Oct. 7-10, 2015; San Antonio.

Disclosure: Esposito reports no relevant financial disclosures.

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