Every year 400,000 - 600,000 people in the United States die from sudden cardiac death. Sudden cardiac death is often caused by irregular electrical impulses, or arrhythmias, in the heart. Arrhythmias can be corrected through pharmacological therapies, device therapies, or both. One type of device therapy, pacemakers, are inserted in the heart to correct arrhythmias. After a period of ventricular pacing, cardiac memory is defined by changes in the T-wave that are persistent upon return to normal activation pathways. During ventricular pacing, regional stroke work in areas closest to the pacing electrode is significantly decreased. We hypothesize that the mechanical function in the region around the pacing site will continue to have altered mechanical function after cession of pacing, in effect showing a mechanical cardiac memory. To test the hypothesis, nine canine models were implanted with pacing electrodes in both the atrium and ventricle. After a forty- minute stabilization period, baseline data were obtained during atrial pacing. Cardiac memory was induced in five canine models through a two-hour period of ventricular pacing followed immediately by atrial pacing. The remaining canine models served as controls, undergoing atrial pacing for two hours. High- density mapper (HDM) was used to determine mechanical function in a region centered approximately 1 cm away from the pacing electrode. No differences in global function (tau, developed pressure, dP/dtmax, dP/dtmin) were found after two hours of ventricular pacing upon return to normal activation pathways. There was a significant decrease in regional stroke work in an area close to the electrode between baseline (5.7 ± 2.6 %), during ventricular pacing (-3.8 ± 0.9 %)(p<0.05) and after two hours of ventricular pacing upon return to normal activation pathways (2.4 ± 1.6 %)(p<0.05). Further, systolic area contraction was also significantly different between baseline (5.0 ± 6.6 %) and after two hours of ventricular pacing upon return to normal activation pathways (0.2 ± 7.4 %)(p<0.05). Diastolic twist and diastolic twist rates showed no significant differences. Finally, contractile principal strain increased by inducing cardiac memory (-2.6 ± 0.3 %) as compared to baseline (-1.1 ± 0.5 %)(p<0.05). These findings suggest there is a mechanical correlation to electrical cardiac memory.

Current treatment options are limited for patients with myocardial infarction or heart failure. Cellular cardiomyoplasty is a promising therapeutic strategy being investigated as a potential treatment, which aims to deliver exogenous cells to the infarcted heart, for the purpose of restoring healthy myocardial mass and mechanical cardiac function. While several cell types have been studied for this application, only bone marrow cells and human mesenchymal stem cells (hMSCs) have been shown to be safe and effective for improving cardiac function in clinical trials. In both human and animal studies, the delivery of hMSCs to infarcted myocardium decreased inflammatory response, promoted cardiomyocyte survival, and improved cardiac functional indices. While the benefits of using hMSCs as a cell therapy for cardiac repair are encouraging, the desired expectation of cardiomyoplasty is to increase cardiomyocyte content that will contribute to active cardiac mechanical function. Delivered cells may increase myocyte content by several different mechanisms such as differentiating to a cardiomyocyte lineage, secreting paracrine factors that increase native stem cell differentiation, or secreting factors that increase native myocyte proliferation. Considerable work suggests that hMSCs can differentiate towards a cardiomyocyte lineage based on measured milestones such as cardiac-specific marker expression, sarcomere formation, ion current propagation, and gap junction formation. However, current methods for cardiac differentiation of hMSCs have significant limitations. Current differentiation techniques are complicated and tedious, signaling pathways and mechanisms are largely unknown, and only a small percentage of hMSCs appear to exhibit cardiogenic traits. In this body of work, we developed a simple strategy to initiate cardiac differentiation of hMSCs in vitro. Incorporating environmental cues typically found in a myocardial infarct (e.g. decreased oxygen tension and increased concentrations of cell-signaling factors), our novel in vitro conditioning regimen combines reduced-O2 culture and hepatocyte growth factor (HGF) treatment. Reduced-O2 culturing of hMSCs has shown to enhance differentiation, tissue formation, and the release of cardioprotective signaling factors. HGF is a pleiotropic cytokine involved in several biological processes including developmental cardiomyogenesis, through its interaction with the tyrosine kinase receptor c-Met. We hypothesize that applying a combined conditioning treatment of reduced-O2 and HGF to hMSCs in vitro will enhance cardiac-specific gene and protein expression. Additionally, the transplantation of conditioned hMSCs into an in vivo infarct model will result in differentiation of delivered hMSCs and improved cardiac mechanical function. In testing our hypothesis, we show that reduced-O2 culturing can enhance hMSC growth kinetics and total c-Met expression. Combining reduced-O2 culturing with HGF treatment, hMSCs can be conditioned to express cardiac-specific genes and proteins in vitro. Using small-molecule inhibitors to target specific effector proteins in a proposed HGF/c-Met signaling pathway, treated reduced-O2/HGF hMSCs show a decrease in cardiac gene expression. When implanted into rat infarcts in vivo, reduced-O2/HGF conditioned hMSCs increase regional cardiac mechanics within the infarct region at 1 week and 1 month. Further analysis from the in vivo study showed a significant increase in the retention of reduced-O2/HGF conditioned hMSCs. Immunohistochemistry showed that some of the reduced-O2/HGF conditioned hMSCs express cardiac-specific proteins in vivo. These results suggest that a combined regimen of reduced-O2 and HGF conditioning increases cardiac-specific marker expression in hMSCs in vitro. In addition, the implantation of reduced-O2/HGF conditioned hMSCs into an infarct significantly improves cardiac function, with contributing factors of improved cell retention and possible increases in myocyte content. Overall, we developed a simple in vitro conditioning regimen to improve cardiac differentiation capabilities in hMSCs, in order to enhance the outcomes of using hMSCs as a cell therapy for the diseased heart.

A isquemia seguida de reperfusão está associada com a ativação de uma cascata de eventos danosos intimamente relacionados ao estresse oxidativo. Durante a isquemia, ocorre o aumento da produção de espécies reativas de oxigênio (EROs), que durante a reperfusão, é favorecida pelo restabelecimento da tensão de oxigênio. Uma vez que a utilização de antioxidantes exógenos parece exercer efeitos benéficos apenas nas fases iniciais das doenças cardiovasculares, o sulforafano (SFN) é uma nova estratégia terapêutica que atua estimulando a produção da maquinaria antioxidante endógena. Este composto é um isotiocianato natural encontrado em vegetais crucíferos, como o broto de brócolis, que demonstra ter um efeito cardioprotetor associado a sua ação estimulatória sobre a reserva antioxidante endógena. Poucos estudos até o momento evidenciaram o potencial cardioprotetor do SFN na isquemia e reperfusão miocárdica. O objetivo deste estudo, portanto, foi testar a hipótese de que o pré-tratamento com SFN poderia modular a função ventricular pós-isquêmica, atenuando o estresse oxidativo de corações isolados de ratos submetidos à isquemia e reperfusão. Ratos Wistar machos pesando entre 250 – 300g foram tratados por três dias com SFN (10mg/kg/dia i.p.) ou veículo. Vinte e quatro horas após a última injeção, os ratos foram mortos e seus corações foram retirados rapidamente e submetidos à isquemia global em aparelho do tipo Langendorff. Os corações foram perfundidos com solução Krebs-Henseleit por um período pré-isquêmico de 20 minutos (estabilização), seguido por isquemia global normotérmica de 20 minutos e 20 minutos de reperfusão. Foram avaliados os seguintes parâmetros: frequência cardíaca (FC), pressão sistólica do ventrículo esquerdo (PSVE), pressão diastólica final do ventrículo esquerdo (PDFVE), índice de contratilidade (+dP/dt), índice de relaxamento (-dP/dt) e pressão de perfusão coronariana (PP). Ao final do protocolo, os corações foram pesados e congelados a -80ºC para posteriores análises bioquímicas e moleculares. Foram analisadas a expressão da SOD, CAT, GPx e heme oxigenase-1 (HO-1) e atividade da SOD, CAT, GPx, TrxR, Grx e GST, bem como a produção de EROs totais e lipoperoxidação evidenciada pelas substâncias reativas ao ácido tiobarbitúrico em homogeneizados dos corações pós isquêmicos. Os resultados deste trabalho mostram que o SFN foi capaz de estimular a 6 maquinaria antioxidante intracelular através do aumento significativo de 66% da expressão de ambas as enzimas SOD e HO-1. Ainda, foi capaz de diminuir a produção de EROs totais em 7%. Entretanto, não foi capaz de estimular a expressão de enzimas como a CAT e a GPx. As atividades destas enzimas, bem como das enzimas TrxR, Grx e GST também não apresentaram diferença significativa entre os grupos. Não foram encontradas diferenças entre os grupos também na lipoperoxidação. Quanto à mecânica cardíaca, o SFN não foi capaz de modular a função ventricular pós isquêmica no regime de tratamento utilizado. Como conclusão, o pré tratamento com SFN na dose de 10 mg/kg/dia foi capaz de estimular a expressão de antioxidantes endógenos importantes, tais como a HO-1 e a SOD. Entretanto, o aumento na expressão não repercutiu em suas atividades enzimáticas e, dessa forma, não se observou modificação na função ventricular pós-isquêmica dos corações submetidos à isquemia-reperfusão. / Ischemia followed by reperfusion activates a cascade of injurious events closely related to oxidative stress. During ischemia, generation of reactive oxygen species increases and even more in reperfusion with the reestablishment of oxygen tension. Once exogenous antioxidants seem to exert beneficial effects only in initial phases of cardiovascular diseases, sulforaphane (SFN) is a new therapeutic strategy which acts stimulating endogenous antioxidant machinery. This compound is a natural occurring isothiocyanate, found in cruciferous vegetables as broccoli sprouts, which demonstrates a cardioprotective capacity associated with its capacity of stimulating the antioxidant endogenous reserve. There are few studies until the moment evidenciating the cardioprotective role of SFN on ischemia-reperfusion. The aim of this study was to test the hypothesis that pre-treatment with SFN could modulate the post-ischemic ventricular function, attenuating oxidative stress in isolated hearts submitted to ischemia-reperfusion. Male Wistar rats weighing between 250 – 300g were treated for three days with SFN (10mg/kg/day i.p.) or vehicle. Twenty four hours after the last injection, rats were decapitated and their hearts were rapidly excised and submitted to global ischemia in a Langendorff’s apparatus. Hearts were perfused with a Krebs-Henseleit solution for a pre-ischemic period of 20 minutes (stabilization), followed by normotermic global ischemia of 20 minutes and 20 minutes of reperfusion. The following parameters were evaluated: heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), contractility index (+dP/dt), relaxation index (-dP/dt) and coronary perfusion pressure (PP). At the end of protocol, hearts were weighed and frozen at -80ºC for posterior biochemical and molecular analysis. The expression of SOD, CAT, GPx and heme oxygenase-1 (HO-1) and activity of SOD, CAT, GPx, TrxR, Grx and GST, as well as total reactive oxygen species production and lipid peroxidation evidenciated by thiobarbituric reactive substances analysis were performed in homogenates of post-ischemic hearts. The results of the present study show that SFN was capable to stimulate the antioxidant intracellular machinery due to a significant increase of 66% in the expression of both SOD and HO-1 enzymes. Moreover, it was capable to reduce ROS production by about 7%. Although, it was not capable to induce CAT and GPx expression. The activities of these enzymes, as well as TrxR, Grx and GST did not present significant differences between groups. 8 No differences between groups were found in lipid peroxidation. Regarding to mechanical function, SFN was not capable to modulate post-ischemic ventricular function with the treatment regimen used. In summary, pre-treatment with 10 mg/kg/day SFN was capable to stimulate the expression of important endogenous antioxidants, such as HO-1 and SOD. However, the increase on the expression did not reflect in its enzymatic activities and, thereby, no modification on post-ischemic ventricular function of the hearts submitted to ischemia-reperfusion was observed.

A isquemia seguida de reperfusão está associada com a ativação de uma cascata de eventos danosos intimamente relacionados ao estresse oxidativo. Durante a isquemia, ocorre o aumento da produção de espécies reativas de oxigênio (EROs), que durante a reperfusão, é favorecida pelo restabelecimento da tensão de oxigênio. Uma vez que a utilização de antioxidantes exógenos parece exercer efeitos benéficos apenas nas fases iniciais das doenças cardiovasculares, o sulforafano (SFN) é uma nova estratégia terapêutica que atua estimulando a produção da maquinaria antioxidante endógena. Este composto é um isotiocianato natural encontrado em vegetais crucíferos, como o broto de brócolis, que demonstra ter um efeito cardioprotetor associado a sua ação estimulatória sobre a reserva antioxidante endógena. Poucos estudos até o momento evidenciaram o potencial cardioprotetor do SFN na isquemia e reperfusão miocárdica. O objetivo deste estudo, portanto, foi testar a hipótese de que o pré-tratamento com SFN poderia modular a função ventricular pós-isquêmica, atenuando o estresse oxidativo de corações isolados de ratos submetidos à isquemia e reperfusão. Ratos Wistar machos pesando entre 250 – 300g foram tratados por três dias com SFN (10mg/kg/dia i.p.) ou veículo. Vinte e quatro horas após a última injeção, os ratos foram mortos e seus corações foram retirados rapidamente e submetidos à isquemia global em aparelho do tipo Langendorff. Os corações foram perfundidos com solução Krebs-Henseleit por um período pré-isquêmico de 20 minutos (estabilização), seguido por isquemia global normotérmica de 20 minutos e 20 minutos de reperfusão. Foram avaliados os seguintes parâmetros: frequência cardíaca (FC), pressão sistólica do ventrículo esquerdo (PSVE), pressão diastólica final do ventrículo esquerdo (PDFVE), índice de contratilidade (+dP/dt), índice de relaxamento (-dP/dt) e pressão de perfusão coronariana (PP). Ao final do protocolo, os corações foram pesados e congelados a -80ºC para posteriores análises bioquímicas e moleculares. Foram analisadas a expressão da SOD, CAT, GPx e heme oxigenase-1 (HO-1) e atividade da SOD, CAT, GPx, TrxR, Grx e GST, bem como a produção de EROs totais e lipoperoxidação evidenciada pelas substâncias reativas ao ácido tiobarbitúrico em homogeneizados dos corações pós isquêmicos. Os resultados deste trabalho mostram que o SFN foi capaz de estimular a 6 maquinaria antioxidante intracelular através do aumento significativo de 66% da expressão de ambas as enzimas SOD e HO-1. Ainda, foi capaz de diminuir a produção de EROs totais em 7%. Entretanto, não foi capaz de estimular a expressão de enzimas como a CAT e a GPx. As atividades destas enzimas, bem como das enzimas TrxR, Grx e GST também não apresentaram diferença significativa entre os grupos. Não foram encontradas diferenças entre os grupos também na lipoperoxidação. Quanto à mecânica cardíaca, o SFN não foi capaz de modular a função ventricular pós isquêmica no regime de tratamento utilizado. Como conclusão, o pré tratamento com SFN na dose de 10 mg/kg/dia foi capaz de estimular a expressão de antioxidantes endógenos importantes, tais como a HO-1 e a SOD. Entretanto, o aumento na expressão não repercutiu em suas atividades enzimáticas e, dessa forma, não se observou modificação na função ventricular pós-isquêmica dos corações submetidos à isquemia-reperfusão. / Ischemia followed by reperfusion activates a cascade of injurious events closely related to oxidative stress. During ischemia, generation of reactive oxygen species increases and even more in reperfusion with the reestablishment of oxygen tension. Once exogenous antioxidants seem to exert beneficial effects only in initial phases of cardiovascular diseases, sulforaphane (SFN) is a new therapeutic strategy which acts stimulating endogenous antioxidant machinery. This compound is a natural occurring isothiocyanate, found in cruciferous vegetables as broccoli sprouts, which demonstrates a cardioprotective capacity associated with its capacity of stimulating the antioxidant endogenous reserve. There are few studies until the moment evidenciating the cardioprotective role of SFN on ischemia-reperfusion. The aim of this study was to test the hypothesis that pre-treatment with SFN could modulate the post-ischemic ventricular function, attenuating oxidative stress in isolated hearts submitted to ischemia-reperfusion. Male Wistar rats weighing between 250 – 300g were treated for three days with SFN (10mg/kg/day i.p.) or vehicle. Twenty four hours after the last injection, rats were decapitated and their hearts were rapidly excised and submitted to global ischemia in a Langendorff’s apparatus. Hearts were perfused with a Krebs-Henseleit solution for a pre-ischemic period of 20 minutes (stabilization), followed by normotermic global ischemia of 20 minutes and 20 minutes of reperfusion. The following parameters were evaluated: heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), contractility index (+dP/dt), relaxation index (-dP/dt) and coronary perfusion pressure (PP). At the end of protocol, hearts were weighed and frozen at -80ºC for posterior biochemical and molecular analysis. The expression of SOD, CAT, GPx and heme oxygenase-1 (HO-1) and activity of SOD, CAT, GPx, TrxR, Grx and GST, as well as total reactive oxygen species production and lipid peroxidation evidenciated by thiobarbituric reactive substances analysis were performed in homogenates of post-ischemic hearts. The results of the present study show that SFN was capable to stimulate the antioxidant intracellular machinery due to a significant increase of 66% in the expression of both SOD and HO-1 enzymes. Moreover, it was capable to reduce ROS production by about 7%. Although, it was not capable to induce CAT and GPx expression. The activities of these enzymes, as well as TrxR, Grx and GST did not present significant differences between groups. 8 No differences between groups were found in lipid peroxidation. Regarding to mechanical function, SFN was not capable to modulate post-ischemic ventricular function with the treatment regimen used. In summary, pre-treatment with 10 mg/kg/day SFN was capable to stimulate the expression of important endogenous antioxidants, such as HO-1 and SOD. However, the increase on the expression did not reflect in its enzymatic activities and, thereby, no modification on post-ischemic ventricular function of the hearts submitted to ischemia-reperfusion was observed.

A isquemia seguida de reperfusão está associada com a ativação de uma cascata de eventos danosos intimamente relacionados ao estresse oxidativo. Durante a isquemia, ocorre o aumento da produção de espécies reativas de oxigênio (EROs), que durante a reperfusão, é favorecida pelo restabelecimento da tensão de oxigênio. Uma vez que a utilização de antioxidantes exógenos parece exercer efeitos benéficos apenas nas fases iniciais das doenças cardiovasculares, o sulforafano (SFN) é uma nova estratégia terapêutica que atua estimulando a produção da maquinaria antioxidante endógena. Este composto é um isotiocianato natural encontrado em vegetais crucíferos, como o broto de brócolis, que demonstra ter um efeito cardioprotetor associado a sua ação estimulatória sobre a reserva antioxidante endógena. Poucos estudos até o momento evidenciaram o potencial cardioprotetor do SFN na isquemia e reperfusão miocárdica. O objetivo deste estudo, portanto, foi testar a hipótese de que o pré-tratamento com SFN poderia modular a função ventricular pós-isquêmica, atenuando o estresse oxidativo de corações isolados de ratos submetidos à isquemia e reperfusão. Ratos Wistar machos pesando entre 250 – 300g foram tratados por três dias com SFN (10mg/kg/dia i.p.) ou veículo. Vinte e quatro horas após a última injeção, os ratos foram mortos e seus corações foram retirados rapidamente e submetidos à isquemia global em aparelho do tipo Langendorff. Os corações foram perfundidos com solução Krebs-Henseleit por um período pré-isquêmico de 20 minutos (estabilização), seguido por isquemia global normotérmica de 20 minutos e 20 minutos de reperfusão. Foram avaliados os seguintes parâmetros: frequência cardíaca (FC), pressão sistólica do ventrículo esquerdo (PSVE), pressão diastólica final do ventrículo esquerdo (PDFVE), índice de contratilidade (+dP/dt), índice de relaxamento (-dP/dt) e pressão de perfusão coronariana (PP). Ao final do protocolo, os corações foram pesados e congelados a -80ºC para posteriores análises bioquímicas e moleculares. Foram analisadas a expressão da SOD, CAT, GPx e heme oxigenase-1 (HO-1) e atividade da SOD, CAT, GPx, TrxR, Grx e GST, bem como a produção de EROs totais e lipoperoxidação evidenciada pelas substâncias reativas ao ácido tiobarbitúrico em homogeneizados dos corações pós isquêmicos. Os resultados deste trabalho mostram que o SFN foi capaz de estimular a 6 maquinaria antioxidante intracelular através do aumento significativo de 66% da expressão de ambas as enzimas SOD e HO-1. Ainda, foi capaz de diminuir a produção de EROs totais em 7%. Entretanto, não foi capaz de estimular a expressão de enzimas como a CAT e a GPx. As atividades destas enzimas, bem como das enzimas TrxR, Grx e GST também não apresentaram diferença significativa entre os grupos. Não foram encontradas diferenças entre os grupos também na lipoperoxidação. Quanto à mecânica cardíaca, o SFN não foi capaz de modular a função ventricular pós isquêmica no regime de tratamento utilizado. Como conclusão, o pré tratamento com SFN na dose de 10 mg/kg/dia foi capaz de estimular a expressão de antioxidantes endógenos importantes, tais como a HO-1 e a SOD. Entretanto, o aumento na expressão não repercutiu em suas atividades enzimáticas e, dessa forma, não se observou modificação na função ventricular pós-isquêmica dos corações submetidos à isquemia-reperfusão. / Ischemia followed by reperfusion activates a cascade of injurious events closely related to oxidative stress. During ischemia, generation of reactive oxygen species increases and even more in reperfusion with the reestablishment of oxygen tension. Once exogenous antioxidants seem to exert beneficial effects only in initial phases of cardiovascular diseases, sulforaphane (SFN) is a new therapeutic strategy which acts stimulating endogenous antioxidant machinery. This compound is a natural occurring isothiocyanate, found in cruciferous vegetables as broccoli sprouts, which demonstrates a cardioprotective capacity associated with its capacity of stimulating the antioxidant endogenous reserve. There are few studies until the moment evidenciating the cardioprotective role of SFN on ischemia-reperfusion. The aim of this study was to test the hypothesis that pre-treatment with SFN could modulate the post-ischemic ventricular function, attenuating oxidative stress in isolated hearts submitted to ischemia-reperfusion. Male Wistar rats weighing between 250 – 300g were treated for three days with SFN (10mg/kg/day i.p.) or vehicle. Twenty four hours after the last injection, rats were decapitated and their hearts were rapidly excised and submitted to global ischemia in a Langendorff’s apparatus. Hearts were perfused with a Krebs-Henseleit solution for a pre-ischemic period of 20 minutes (stabilization), followed by normotermic global ischemia of 20 minutes and 20 minutes of reperfusion. The following parameters were evaluated: heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), contractility index (+dP/dt), relaxation index (-dP/dt) and coronary perfusion pressure (PP). At the end of protocol, hearts were weighed and frozen at -80ºC for posterior biochemical and molecular analysis. The expression of SOD, CAT, GPx and heme oxygenase-1 (HO-1) and activity of SOD, CAT, GPx, TrxR, Grx and GST, as well as total reactive oxygen species production and lipid peroxidation evidenciated by thiobarbituric reactive substances analysis were performed in homogenates of post-ischemic hearts. The results of the present study show that SFN was capable to stimulate the antioxidant intracellular machinery due to a significant increase of 66% in the expression of both SOD and HO-1 enzymes. Moreover, it was capable to reduce ROS production by about 7%. Although, it was not capable to induce CAT and GPx expression. The activities of these enzymes, as well as TrxR, Grx and GST did not present significant differences between groups. 8 No differences between groups were found in lipid peroxidation. Regarding to mechanical function, SFN was not capable to modulate post-ischemic ventricular function with the treatment regimen used. In summary, pre-treatment with 10 mg/kg/day SFN was capable to stimulate the expression of important endogenous antioxidants, such as HO-1 and SOD. However, the increase on the expression did not reflect in its enzymatic activities and, thereby, no modification on post-ischemic ventricular function of the hearts submitted to ischemia-reperfusion was observed.

Yes / Introduction: Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to ‘try out’ a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to patient related factors which can change from day-to-day and can thus make device comparisons unreliable. To determine whether a device’s mechanical function consistently has a more meaningful impact on gait than patient-related factors, the present study undertook quantitative gait analyses of a trans-tibial amputee walking using two different foot-ankle devices on two occasions over a year apart. If the observed differences present between devices, established using quantitative gait analysis, were in the same direction and of similar magnitude on each of the two occasions, this would indicate that device-related factors were more important than patient-related factors. Methods: One adult male with a unilateral trans-tibial amputation completed repeated walking trials using two different prosthetic foot devices on two separate occasions, 14 months apart. Walking speed and sagittal plane joint kinematics and kinetics for both limbs were assessed on each occasion. Clinically meaningful differences in these biomechanical outcome variables were defined as those with an effect size difference (d) between prosthetic conditions of at least 0.4 (i.e. ‘medium’ effect size). Results: Eight variables namely, walking speed, prosthetic ‘ankle’ peak plantar- and dorsi- flexion and peak positive power, and residual knee loading response flexion, peak stance-phase extension and flexion moments and peak negative power, displayed clinically meaningful differences (d > 0.4) between foot devices during the first session. All eight of these showed similar effect size differences during the second session despite the participant being heavier and older. Conclusions: Findings suggest that a prosthetic device’s mechanical function consistently has a more meaningful impact on gait than patient-related factors. These findings support the current clinical practice of making decisions regarding prosthetic prescription for an individual, based on a single session evaluation of their gait using two different devices. However, to confirm this conclusion, a case series using the same approach as the present study could be undertaken.

No description available.