Symmetry function - An effective tool for evaluating the gait symmetry of trans-femoral amputees.

Abstract

Prostheses can help persons with trans-femoral amputation (TFA) regain normal function, but such individuals still exhibit gait deviations expressed in gait asymmetries. We apply a specialised tool, the Symmetry Function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables and to identify areas with large side deviations (exceeding defined ±5% threshold) in the movement cycle. Which movements and joints or GRF components revealed the most significant side deviations in the movement cycle? When exactly are they located in the gate cycle? In this retrospective observational study, an instrumented motion analysis system was used to register the gait of fourteen patients after unilateral TFA. Measurements involved evaluating the time series of gait variables characterising a range of motion and the ground reaction force components. Comparison of the prosthetic (involved) limb with the sound (uninvolved) limb in TFA patients was carried out on the basis of the Symmetry Function values. The Symmetry Function proved to be an effective tool to localise the regions of asymmetry and limb dominance in the full gait cycle. The difference between sides revealed by the Symmetry Function was the highest for the pelvis and the hip. In the sagittal plane, the pelvis was asymmetrically tilted, reaching the highest SF value of more than 25 % at 60 % cycle time. In the transverse plane, the pelvis was even more asymmetrically positioned throughout the entire gait cycle (50 % difference). The hip in the frontal plane reached a 60 % difference throughout the single support phase for the involved and then for the uninvolved limb. The Symmetry Function allows for the detection of gait asymmetries, temporal shifts in the gait phases and may assess the precise in time adaptation of prostheses and rehabilitation monitoring, especially in unilateral impairments.