How Does Physical Activity Affect Residual Limb Volume Change, Comfort and Gait Symmetry on Traumatic Transfemoral Amputees?

Abstract

There is a considerable amount of young adults who become amputees due to war and violence. For this population, a successful adaptation to their prosthesis depends on the socket fit, which in turn is caused by the volume change of the residual limb during the day. The literature reports several investigations on this topic, most of which use subjects walking on a treadmill to simulate their daily activity. However, this studies are focused on transtibial amputees and do not mention the relationship between this physical activity and other variables such as comfort, volume changes and gait. Therefore, the objective of this paper is to determine the effect of physical activity on the volume of the residual limb, the comfort and the symmetry of gait in traumatic transfemoral amputees. Plaster positive molds of the residual limb, the comfort perception and the gait data of five individuals were obtained at the first time of the day and after three sessions of treadmill walking of 15, 30 and 45 minutes. The positive molds of each individual were scanned and then, the volume was calculated. The gait data was acquired using a marker-based motion capture system and processed to obtain spatio-temporal, kinematic and kinetic parameters, including the Gait Deviation Index (GDI). Based on the literature, specific points of the gait data were selected and the symmetry index was obtain for each of them. A short comfort test was used after each session of treadmill walking. Data was analyzed throughout the tests within each subject. Statistical analysis was performed for the volume and the gait variables to check for statistical significance. After physical activity, a tendency towards residual limb volume decrease was found on almost all subjects, although it was not significant. The percentage of volume change obtained on almost all subjects are within the range considered “good socket fit” according to previous authors. Our results suggest that transfemoral amputees may have smaller volume changes than transtibial after treadmill walking. Significant difference was found on the symmetry index of “Swing phase” between the baseline and the 45-minute test. The values of gait symmetry on the gait parameters were consistent with previous findings regarding transfemoral amputees. The difference that arise may be due to the sample difference (cause of amputation, difference in prosthetic elements and use of walking aids). The lowest symmetry was noticed on the ankle kinematics. The comfort did not significantly change with the selected amount of physical activity. In subsequent research, it is recommended to increase the intensity or time of physical activity and/or increase the number of participants. This results can help the understanding of how the socket/residual limb interface behaves which can improve the design and prescription of prosthetic components.