Physical Therapy

Improved Prosthetic Gait Following Amputee-Specific Physical Therapy.

Following amputation, an amputee must learn to walk again using a prosthesis. A goal of prosthetic rehabilitation is to reduce and eliminate asymmetries between the prosthetic leg and sound leg which may decrease the negative effects of long term force and work demands on the sound leg. An amputee-specific physical therapy program provides structured motor learning to aid in developing proper gait mechanics. However, physical therapy is not standard of care for all individuals receiving their first prosthesis due to limited evidence showing improved gait. Thus, the purpose of this study was to determine whether amputees receiving physical therapy have better gait mechanics than those that do not. It was hypothesized that those who underwent an amputee-specific physical therapy program would display a more symmetrical gait pattern. Transtibial amputees walked overground at self-selected pace while kinetic (600Hz) and kinematic (60Hz) data were collected. The therapy group had previously received 2-3 therapy sessions per week for 3 months. Asymmetries were determined through dependent t-tests (α=0.05) comparing sound leg and prosthetic leg kinetic variables. Of the 23 kinetic variables tested, 17 variables showed significant difference between the sound leg and prosthetic leg for the group that did not receive the amputee-specific physical therapy. For the group that had previously received the therapy, only 4 variables showed differences between the sound and prosthetic leg. Thus, we showed that individuals partaking in amputee-specific physical therapy have a more symmetrical gait which results on less force and energy demands on the sound leg.
Listed In: Biomechanics, Gait, Physical Therapy


HIP JOINT TORQUES DURING A GOLF SWING AFTER A TOTAL HIP REPLACEMENT: A CASE SERIES

Purpose: Total Hip Replacements (THR) are common procedures for older people who suffer from degenerative joint disease. Golf is a popular leisure sport played by older Americans including those with THR. Hip torques encountered in a golf swing after THR has not been reported. The purpose of this study is to describe 3D hip joint torques generated during a golf swinging by those with THR. Methods: Three male amateur golfers who were at least 1 year post THR (ages 59-71 year old and right hand dominant, (2 were left THR) participated. Golf handicap ranged from 16-18. All participants completed the Hip Harris Score. Passive reflective markers were placed on key boney anatomical landmarks. During data collection, participants completed ten swings using a standardized driver, after a warm up. Kinetics and kinematics were captured using a 10 camera Motion Analysis system and two AMTI forceplates. Inverse dynamics procedure was used to calculate peak hip torques in all three planes. Hip torques were normalized and presented as internal torques. Comparisons were made to previously collected similarly aged senior group. Results: Average Club head velocity was slower than senior group. Sagittal Plane: THR golfers exhibited the greatest torque similar to senior group. Frontal plane: THR golfers demonstrated a lower hip adductor torque on the lead leg compared to the trail leg and senior group. Transverse plane: THR exhibited higher hip external rotation torques compared to the internal rotation torques and the senior group. Conclusion: 3-D peak hip torques generated during the golf swing by persons with a THR are greatest in the sagittal plane. THR golfers demonstrated slower club head speed but generated higher hip torques in the transverse plane as compared to those without a THR. Hip external rotation torque was higher in all of the THR compared to the senior group. Clinical Significance: Subjects with a THR may be prone to abnormal forces in the transverse plane during the golf swing. Future studies are needed to determine impact on return to golf decisions following a THR.
Listed In: Biomechanics, Physical Therapy, Sports Science