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

Objective

For lower limb amputees, the fit of the socket determines the acceptance or rejection of a prosthesis. On mature limbs, socket fit is mainly affected by the volume change of the residual limb during the day, partly due to activities such as walking and translating. Since walking is the most common activity of daily living, several researchers have reproduced the physical activity usually performed during a workday by putting the amputee on a treadmill walking workout in a laboratory setting. These studies, however, included only transtibial amputees and did not examine the effects on the subjects’ gait, the comfort and the volume change of the residual limb. 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.

Methods

The volume 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 volume of the residual limb was obtained by scanning the positive molds of each individual on each session and then calculating the volume using GeomagicDesign software. The gait data was acquired using a marker-based motion capture system from SMART-D/BTS. Spatio-temporal, kinematic and kinetic parameters, including the Gait Deviation Index (GDI), were calculated for the five subjects using the SMART-Analyzer software. A short comfort test was used after each session of treadmill walking. Data was analyzed throughout the tests within each subject.

Results

After physical activity, a tendency towards residual limb volume decrease was found on almost all subjects. The findings suggest that transfemoral amputees may have smaller volume variations than transtibial after treadmill walking tasks. The values of gait symmetry on spatiotemporal, kinematic and kinetic parameters were consistent with previous findings reported on the literature about transfemoral amputees. A slight alteration in symmetry was noticed on the ankle kinematics. The comfort did not significantly change with the selected amount of physical activity.

Conclusion

This study could be the first contribution to understanding the relationship between the physical activity, volume and gait symmetry on transfemoral amputees. The results are applicable to well-fitted individuals using suction as the suspension system. In subsequent research, it is recommended to increase the intensity or time of physical activity, to the point that the subject reports discomfort, to detect if in this situation he/she shows significant changes on the volume of the residual limb and the gait symmetry. Better knowledge of how the socket/residual limb interface behaves can help professionals in the design and prescription of prosthetic components.