1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-35
ENERGY EXPENDITURE DURING OVER GROUND WALKING
IN PAEDIATRIC AMPUTEES
Jeans, KA, MS and Karol, LA, MD
Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
Summary/conclusions
Results for self selected walking (SSW) in children with lower extremity amputation show that
amputees of all levels tend to reduce their walking speed (a significant decrease was found in
the hip disarticulation (HD) group), but the cost of ambulation and heart rate (HR) are only
significantly increased in the HD group, compared to normal. Our study fails to support
previous adult research that shows that as the level of amputation ascends the leg, energy cost
and HR increase while SSW velocity decreases. This study demonstrates that although
amputees choose to walk at a slightly slower SSW speed, the energy cost and HR of
participants with Symes, below knee amputations (BKA), knee disarticulations (KD) and
above knee amputations (AKA) are within normal range during SSW.
Introduction
In reviewing the amputee literature regarding energy expenditure, it is clear that the adult
population is well described [1], but less information can be found on the paediatric
population. Herbert et al compared children with BKA to normal during treadmill walking at
self selected speed and found that patients with BKA were able to maintain similar walking
speed but had significantly higher energy costs than patients with intact limbs [2]. They did
not find significant differences in HR, as the adult literature reports [1]. Ashley et al. measured
HR and SSW velocity in children with Symes, BKA, KD and AKA and found that all groups
walked at a slightly decreased speed, with an increased HR [3].
Statement of clinical significance
It is unclear if the results reported in the adult literature can be directly related to the paediatric
population at multiple levels of amputation. The purpose of this study is to compare the energy
efficiency of children with lower extremity amputation between groups and to age matched
normals.
Methods
Unilateral amputees over the age of five were invited to participate in this IRB approved study.
Exclusion criteria for testing included: prosthetic use of less than 6 months, prosthetic
complications and skin breakdown. All participants were required to refrain from eating two
hours prior to testing. Oxygen consumption was collected using the K4 b2 oxygen analysis
telemetry unit (Cosmed, Rome, Italy). A five minute seated rest period was collected prior to a
ten minute walk at a self selected speed around a 40 meter track. One minute of steady-state
data was selected from rest and SSW, and reduced. Patients were grouped according to level
of amputation: Symes, BKA, KD, AKA and HD. Each amputee was then compared to the
appropriate group of age matched normals: Child 6-12yrs or Teen 13-19yrs. Variables
analyzed were resting VO2 Rate (ml/kg/min), resting HR (bpm), VO2 Cost (ml/kg/m), HR
(bpm) and velocity (m/min). A Tukey post-hoc multiple comparison procedure was run to
compare amputee levels and to compare amputees with normal. The overall error rate is
controlled at 0.05.
Results
Forty-three unilateral amputees and 39 normal children participated in this study. Subject
demographics can be seen in Table 1. All amputees were age matched and compared to the
appropriate group. The Symes group had significantly higher BMI than normal. No other
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