The Locomotory Index: a New Proposal for Evaluating Walking Impairments

Abstract

The energy cost of walking per unit of body mass and of distance (Cw) was determined before total hip (n = 17) or total knee (n = 16) arthroplasty and ten days, two, six or twelve months after surgery. The ratio of Cw observed on patients (at the self selected speed) relative to that observed in healthy subjects of the same age at the same speed was defined Locomotory Index (Index Locomotorius, IL). So, IL is a quantitative measure of the economy of walking; for both groups of patients IL amounted to about 1.40 before surgery; it increased significantly 10 days after the operation to 1.86 or to 1.58, for hip or knee patients, respectively. Two, six and twelve months after the operation IL had decreased significantly below presurgery values (1.29, 1.30 and 1.30) for knee replacement, whereas it was still larger, albeit not significantly so, after hip replacement (IL = 1.61; 1.56 and 1.50). It was also observed that the self selected speed increased and the traditional clinical scores (Harris for hip and B.O.A. for knee) improved, with decreasing IL. It is suggested that IL is a useful quantitative tool, in addition to the more traditional clinical scores, for evaluating ambulatory disability in patients.

Coxarthrosis · gonarthrosis · energy cost of walking · self-selected speed · arthroplasty

References

• 1 Arborelius M M, Carlsson A S, Nilsson B E. Oxygen intake and walking speed before and after total hip replacement.  Clin Orthop. 1976;  121 113-115
• 2 Bard G. Energy expenditure of hemiplegic subjects during walking.  Arch Phys Med Rehab. 1963;  44 368-370
• 3 Bernardi M, Macaluso A, Sproviero E. Cost of walking and locomotor impairment.  J Electromyogr Kinesiol. 1999;  9 149-157
• 4 Brown M, Hislop H, Waters R, Porell D. Walking efficiency before and after total hip replacement.  Phys Ther. 1980;  60 1259-1263
• 5 Buckley J C, Spence W D, Solomonidis S E. Energy cost of walking: comparison of “intelligent prosthesis” with conventional mechanism.  Arch Phys Med Rehab. 1997;  78 330-333
• 6 Campailla E, di Prampero P E, Fusi S, Paschina E, Causero A. Il costo energetico della deambulazione prima e dopo intervento di protesi d’anca e di ginocchio.  Giornale Italiano di Ortopedia e Traumatologia. 1998;  XXIV 59-67
• 7 Cavagna G A, Heglund N C, Taylor C R. Mechanical work in terrestrial locomotion: two basic mechanisms for minimizing energy expenditure.  Am J Physiol. 1977;  233 R243-R261
• 8 Cerny K, Waters R, Hislop H, Perry J. Walking and wheel-chair energetics in persons with paraplegia.  Phys Ther. 1980;  60:9 1133-1139
• 9 Chin T, Sawamura S, Fujita H. The efficacy of physiological cost index (PCI) measurement of a subject walking with an Intelligent Prosthesis.  Prosthet Orthot Int. 1999;  23 45-49
• 10 Corcoran P J, Jebsen R H, Brengelmann G L, Simons B C. Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation.  Arch Phys Med Rehab. 1970;  51 69-77
• 11 di Prampero P E. La locomozione umana su terra, in acqua, in aria. Milano; Edi Ermes 1985
• 12 Fischer S V, Gullickson G. Energy cost of ambulation in health and disability.  Arch Phys Med Rehab. 1978;  59 124-133
• 13 Himann J E, Cunningam D A, Rechnitzer P A, Paterson D H. Age related changes in speed of walking.  Med Sci Sport Exer. 1988;  290 161-166
• 14 Margaria R. Sulla fisiologia e specialmente sul consumo energetico della marcia e della corsa a varia velocità ed inclinazione del terreno.  Atti Acc Naz Lincei. 1938;  7 299-368
• 15 Mattsson E, Brostrom L A, Borg J, Karlsson J. Walking efficiency before and after long term muscle stretch in patients with spastic paraparesis.  Scand J Rehab Med. 1990;  22 55-59
• 16 Mattsson E, Brostrom L A, Linnarson D. Walking efficiency after cemented and noncemented total hip arthroplasty.  Clin Orthop. 1990;  254 170-179
• 17 Mc Beath A A, Bahrke M S, Balke B. Walking efficiency before and after total hip replacement as determined by oxygen consumption.  J Bone Joint Surg. 1980;  62-A 807-810
• 18 Olgiati R, Jaquet J, di Prampero P E. Energy cost of walking and exertional dispnea in multiple sclerosis.  Am Rev Respir Dis. 1986;  134 1005-1010
• 19 Pugh L GCE. The oxygen intake and energy cost of walking before and after unilateral hip replacement, with some observations on the use of crutches.  J Bone Joint Surg. 1973;  55B 742-745
• 20 Skinner H B. Pathokinesiology and total joint arthroplasty.  Clin Orthop. 1993;  288 78-86
• 21 Tantucci C, Masucci M, Piperno R, Grassi V, Sorbini C A. Energy cost of exercise in multiple sclerosis patients with low degree of disability.  J Can Soc Multiple Sclerosis. 1996;  2 161-167
• 22 Tesio L, Civaschi P, Tessari L. Motion of the center of gravity of the body in clinical evaluation of gait.  Am J Phys Med. 1985;  64:2 57-70
• 23 Tesio L, Roi G S, Moller F. Pathological gaits: inefficiency is not a rule.  Clin Biomech. 1991;  6 47-60
• 24 Thys H, Willems P A, Saels P. Energy cost, mechanical work and muscular efficiency in swing-through gait with elbow crutches.  J Biomechanics. 1996;  29 1473-1482
• 25 Waters R L, Perry J, Antonelli D, Hislop H. Energy cost of walking in amputees: influence of level of amputation.  J Bone Joint Surg. 1976;  58 42-46
• 26 Waters R L, Perry J, Conaty P, Lunsford B, O’Meara P. The energy cost of walking with arthritis of the hip and the knee.  Clin Orthop. 1987;  214 278-284
• 27 Zamparo P, Francescato M P, De Luca G, Lovati L, di Prampero P E. The energy cost of level walking in patients with hemiplegia.  Scand J Med Sci Sports. 1995;  5 348-352
• 28 Zamparo P, Francescato M P, Diella D. Costo energetico della marcia in piano in soggetti affetti da emiplegia o coxartrosi.  Il Friuli Medico. 1993;  48 27-41
• 29 Zamparo P, Perini R, Orizio C, Sacher M, Ferretti G. The energy cost of walking or running on sand.  Eur J Appl Physiol. 1992;  65 183-187