Effects of a Powered Ankle-Foot Prosthesis and Device-Specific Physical Therapy on Function and Pain for Individuals Living with Transfemoral Limb Loss
Abstract
Background: Individuals living with above-the-knee, or transfemoral, amputations often walk asymmetrically, which puts more stress on their lower back and non-amputated, or intact, limb. The calf muscle plays a key role in pushing the body forward at the end of each step, but standard prosthetic feet, known as energy-storing and returning (ESR) feet, are not able to provide an adequate push for people with amputation. Advances in technology have resulted in new prosthetic feet that incorporate a motor to supply power to the foot to better propel the individual with amputation forward. Some recent research has shown that use of a powered prosthetic foot better mimics the calf muscle and can help individuals with amputation to walk more symmetrically. However, skilled physical therapy (PT) may be needed to train individuals with amputation to maximize the use of the powered prosthesis, which may potentially reduce or eliminate the stress and pain to the lower back and intact limb. If the use of a powered prosthetic foot does reduce and/or eliminate asymmetrical walking in these patients, it has not been shown if skilled PT is needed to maximize use of the powered device or if the patient will be able to gain the benefits from the device without skilled PT because it functions similar to the lost limb. Objectives: (1) To determine the effects of a powered prosthetic foot, as well as skilled PT, on (a) walking patterns, (b) physical function, and (c) pain for individuals with a transfemoral, or above the knee, amputation. (2) To develop preliminary rehabilitation guidelines for powered devices to minimize gait problems and maximize function, as well as establish guidelines to help clinicians prescribe powered prosthetic feet to appropriate candidates. It is hypothesized that use of a powered prosthetic foot, coupled with a skilled PT focused on training with the powered device, will result in improved walking patterns, which may decrease pain and improve function. Study Design: This study will test 30 individuals over a 3-year period with an above-the-knee amputation who receive treatment at the Veterans Affairs New York Harbor Healthcare System (VANYHHS) and Walter Reed National Military Medical Center (WRNMMC). Subjects will be placed into two groups: Group A will be fit with a powered prosthetic foot and undergo a formal skilled PT intervention, while Group B will be fit with a powered prosthetic foot, but will not receive formal PT. All participants will complete a baseline evaluation on their current prosthesis, including a computer analysis of their walking, measures of physical function, pain assessments, as well as a test to assess psychosocial parameters that need to be considered when interpreting the results. Group A will then receive eight sessions of skilled PT focused on training with the specific device. Group B will receive basic device training and education. Both groups will complete computerized walking evaluations, physical function measurements, and pain assessments after 4 and 8 weeks of powered prosthesis use. Application and Impact: Over 1,660 Service members wounded in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn have sustained a major limb (i.e., leg) amputation. Many more Veterans are living with amputation due to previous conflicts or systemic conditions, such as dysvascular disease and diabetes. In fact, there are approximately 1.9 million Americans living with limb loss today, with an estimated 185,000 persons who undergo an amputation each year. Determining the appropriate prosthetic foot prescription and establishing a PT program will allow for shortened recoveries, improved outcomes for injured Service members and Veterans, and improved walking patterns that will decrease the potential of secondary health outcomes, such as low back pain or intact knee arthritis in those who have already sustained this injury. The results from this study ca
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710568
Entities
People
- Jason Maikos
Organizations
- United States Army