Changes in Trunk and Pelvis Motion among Persons with Unilateral Lower Limb Loss during the First Year of Ambulation

Publication date: Available online 19 September 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Caitlin E. Mahon, Courtney M. Butowicz, Christopher L. Dearth, Brad D. Hendershot

Abstract

Objective

To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized.

Design

Inception cohort with up to five repeated evaluations, including both biomechanical and subjective outcomes, during a one-year period (0, 2, 4, 6, and 12-months) after initial ambulation with a prosthesis.

Setting

Biomechanics laboratory within Military Treatment Facility.

Participants

Twenty-two males with unilateral transtibial limb loss and ten males with unilateral transfemoral limb loss.

Interventions

Not applicable

Main Outcome Measures

Tri-planar trunk-pelvis range of motion, and intersegmental coordination (continuous relative phase), obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking velocities. Self-reported presence and intensity of low back pain.

Results

An interaction effect between time and group existed for sagittal (p=.039) and transverse (p=.009) continuous relative phase at self-selected walking velocity, and transverse trunk range of motion (p=.013) and sagittal continuous relative phase (p=.005) at controlled walking velocity. Trunk range of motion generally decreased and trunk-pelvis coordination generally increased with increasing time after initial ambulation. Sagittal trunk and pelvis ROM were always less and frontal trunk-pelvis coordination always greater for persons with more distal limb loss. Low back pain increased for persons with transtibial limb loss and decreased for persons with transfemoral limb loss following the 4-month timepoint.

Conclusions

Temporal changes (or lack thereof) in features of trunk-pelvis motions within the first year of ambulation help elucidate relationships between (biomechanical) risk factors for low back pain after limb loss.

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