RESUMEN
Rehabilitation for lower-limb amputees needs to focus on restoration of daily functions and independent locomotion. As gait is reestablished, reorganization of the motor pattern takes place in order to optimize the functions of the locomotor system. Biomechanics is a field of study that enables understanding of this reorganization. From such knowledge, appropriate strategies for recovering the autonomy of the means of locomotion can be established. Thus, this paper had the aim of reviewing the current status of the biomechanics of locomotion among unilateral transtibial amputees. To achieve this aim, papers written in English or Portuguese and published up to 2005 were selected from the Cochrane Library, PubMed, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Dedalus databases. In cases of transtibial amputation, the absence of plantar flexors negatively affects locomotion. Increased absorption and energy generation by the muscles that control the hip joint of the amputated leg can be considered to be the main compensatory strategy developed by unilateral transtibial amputees during gait. Factors associated with the characteristics of the amputation, prosthesis and experimental protocol used directly influence the results.
A reabilitação de amputados de membro inferior deve focar a restauração das funções cotidianas e da locomoção independente. À medida que a marcha é restabelecida, ocorre a reorganização do padrão motor com a finalidade de otimizar as funções do sistema locomotor. A Biomecânica é uma área de estudo que possibilita a compreensão desta reorganização. A partir desse conhecimento, podem-se estabelecer estratégias adequadas para recuperação da autonomia dos meios de locomoção. Assim, este artigo tem por objetivo criar um sumário do atual status do estudo da biomecânica da locomoção de amputados transtibiais unilaterais. Para alcançar tal objetivo foram selecionados artigos nas bases de dados Cochrane Library, PubMed, SciELO (Scientific Electronic Library Online), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) and Dedalus escritos em língua inglesa e portuguesa publicados até o ano de 2005. Na amputação transtibial, a ausência dos flexores plantares repercute de forma negativa na locomoção. O aumento da absorção e geração de energia pelos músculos que controlam a articulação do quadril da perna amputada pode ser considerado a principal estratégia compensatória desenvolvida por amputados transtibiais unilaterais durante a marcha. Fatores ligados às características da amputação, prótese e protocolo experimental estudados influenciam diretamente os resultados analisados.
Asunto(s)
Humanos , Amputación Quirúrgica , Amputados/rehabilitación , Miembros Artificiales , Marcha/fisiología , Amputación Quirúrgica/rehabilitación , Fenómenos Biomecánicos , Tibia/cirugíaRESUMEN
Normalization is a process to remove the effect of a variable into another to decrease its variability. Normalization is also a process to scale a variable. For gait analysis, the most common normalization is to divide Ground Reaction Force by body weight. The objective of this paper is to analyze the effects of normalizalizing a set of ground reaction force parameters. Thirteen adults were the subjects of this study. A force plataform was used to measure the vertical component of ground reaction (vGRF) during stance phase. Twenty samples for each subject were obtained (10 for walking with and other 10 for walking barefoot). For each condition, 5 samples were due to the left support and other 5 were due to the rigth support. Some parameters were calculated using vGRF: intensity, impulse and inclination. The raw signal was filtered with low-pass, 2nd order, zero lag, Butterworth filter at 100 Hz. For statistical analysis, different produres were used: to compare groups, we used two-way analysis of variance; to study the effect of normalization into the signal's variability, we used the principal component analysis. The main results suggest that normalization affects those paraeters, and it is not affected by shoes condiction, chaging the metric among them. However, this is not a pure lenear effect and probably it is also affected by a covariable. We suggest that time is one covariate. We also suggest that other experiments should be run to analyze such effect, considering as covariables gait speed, time, shoes and frequency components.
Asunto(s)
Humanos , Fenómenos Biomecánicos , MarchaRESUMEN
Papers show that related to the amputation condition and the prosthesis may affect the gait patterns of transtibial amputee population. Although, it is not considered the effects of prothesis-shoes-lower limb. The aim of this paper is to analyze the dynamical and electromiografical signals during gait of one side transtibial amputee, considering the interaction between prothesis and shoes for the prosthec leg (PP) and the interaction between shoes and lower limb for the other leg (PNA). Three amputees wearing sport shoes volunteered for study and wallked on two velocities: self-serlected and fast. An instrumented treadmill with two force plates (Gaitway Kistler) was used to measure the vertical component of the Ground Reaction Force (GRF) and one electromiographical system (Bagnoli 8 Delsys Inc.) was used to measure the tempoal mioeletric activity of selected muscles: Vasto Lateralis (GL) for PNA. During fast velocity, PP presented largested largest Fyl, FY2, Fy_min and D_y. VL and BF for PP showed longer activation during gait. Comparing PP anda PNA, the interaction between lower limb and shoes and the interaction between prosthesis-shoes should be considered for gait analysis in one side transtibial amputee patients.