Motio Case Study 1: A Comprehensive Analysis of Michael Scott’s Motio Functional Report
In the complex journey of prosthetic rehabilitation, each individual is unique and filled with different challenges and triumphs. This blog post marks the beginning of the case study analysis series, where we’ll share different patient stories that underwent activity evaluations using the Motio StepWatch System. Let’s introduce our first patient, Michael.
In 2018, Michael underwent an amputation below the knee on his left leg due to osteosarcoma. In 2019, he received his first prosthesis. Michael is a resident of a rural town in Portugal known for frequent ups and downs. Even though he didn’t have any complaints and always tried to maintain an active routine, he was scared to walk and that doing so would cause problems on his residual limb.
Given the challenges Michael faces daily and taking into account his assessment of activity, the prosthetist wanted to evaluate his actual activity and potential using real-world data to understand how they could improve patient care. Eleven days were spent on the analysis using the Motio StepWatch System.
In-Clinic Tests
AMPPRO®: K4 (44 out of 47)
PLUS-M™: 55.3 (Indicative of a level of mobility better than 70.2% of people with unilateral lower limb amputation.)
TUG: 9.9 seconds (>19 seconds is not indicative of fall risk)
Results and Analysis
Figure 1 – Michael Scott Daily Highlights.
Analyzing Michael’s daily activity highlights it is possible to understand how active he was during the data collection:
The average daily step count was around 30% higher than previously found for a TT amputee [1] (even though they are not reference values). On his most active day, Michael's step count exceeded twice this value, demonstrating his high level of activity.
Top Speed and Top Cadence indicate that he can walk quickly and with a high-top cadence, as expected from a K4 patient [2].
The maximum continuous walking distance clearly demonstrates that Michael has the full potential to be a community ambulator when compared to the minimal distance of ≈984 feet for community ambulation (K3)2-4. Looking at his best day, he scored 80% higher than this benchmark.
Figure 2 – Michael Scott Active Time.
Figure 3 - Michael Scott’s Daily Steps Graph.
By analyzing his active time, we can identify Michael’s potential to change cadence throughout the day. Notably, he devoted nearly one-third of his active time to high-intensity activities. Additionally, it is possible to understand how consistent he was during the evaluation by looking at the Daily Activity Intensity Graph and the Daily Steps Graph.
Except for the first and last days (which may not demonstrate his daily routine since he had to go to the O&P Clinic), there was one day when he didn't reach the 8333-step benchmark for a TT amputee [1] (not a reference value). However, we can notice that this happens right after his “best day” step count, suggesting he may have needed additional rest due to fatigue.
Figure 4 - Michael Scott Blind Outcome Evaluations.
The blind outcome evaluations demonstrate a medium-high performance. While his average distance of 2-minute continuous walk (84±22 meters) falls within the K2 range of the 2MWT6, it's noteworthy that he was able to achieve this more than 200 times. It's important to acknowledge that the circumstances are not controlled, and this value does not directly correlate with the 2MWT. Upon analyzing the 6-minute continuous walk, Michael demonstrated a result comparable to the reference value of the 6MWT for a K3 patient [7-8], with a total of 11 occurrences. Furthermore, the final blind outcome evaluation also suggests that Michael fits into the K3 patient population [9-11].
Based on these results, it’s reasonable to consider Michael’s clinician's recommendation for a functional K3. The results show that he is consistent throughout the day, he can walk fast and at high-intensity activity levels, and he can easily vary his cadence, demonstrating that he must have the “ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion”. However, does he have potential that exceeds the basic ambulation skills and exhibits high energy levels?
Figure 5 – Michael Scott Daily Step Activity Graphs.
In these two daily-step activity graphs, we can observe that Michael:
Can easily change his cadence during the day; there are lots of peaks and valleys at different activity intensity levels.
Has the potential to exercise or do other high-stress activities; several thick bands of peaks break the “high intensity” threshold.
Spends a lot of energy when walking or exercising; with little to no extended periods of inactivity detected.
With this analysis in mind, it was time to recommend a functional level for Michael to finally get the Motio Functional Level and fully understand his activity and potential. The prosthetist recommended a K3, which, when averaged with the activity scores, resulted in a Motio Functional Level of 3.9.
Figure 6 – Michael Scott Clinician Recommendation, Activity Scores and Motio Functional Level.
Conclusion
After analyzing the Motio Functional Report, the prosthetist concluded that Michael has a lot of potential to do more than what he is doing at the moment. Even though the clinician's recommendation was a K3, he still scored a High K3 Functional Level. His results demonstrated that maybe with better prosthetic components and a personalized training program, Michael can achieve the “K4 threshold” easily.
With the acquired real-world data, the prosthetist was able to better understand what Michael was achieving in his daily routine, besides all the obstacles and circumstances he encounters on a regular basis. It opened a new conversation with the Rehabilitation Team, to discuss the next steps in his rehabilitation process.
“The Motio StepWatch System provides the Rehabilitation Team with objective and real-world data, eliminating the need to rely solely on subjective assessments. This technology enables us to observe an amputee's activity and gait quality beyond the clinic setting. Often, in clinical environments, amputees may adopt specific gait patterns and qualities as instructed, which may not necessarily translate into their daily routines. The availability of this data is crucial not only for prosthetists but also for physiotherapists and the entire rehabilitation team. It enables the adaptation of protocols and processes to align with the real-world experiences and needs of each lower-limb amputee.”
Sara Marques, CPO, MG Ortopedia
“I believe the prescription of prosthetic components could be better tailored to the patient's daily needs if objective data is used. Sometimes, just giving our feedback and presenting our complaints to the rehabilitation team may not be enough.”
Michael, Bellow Knee amputee since 2018
References
C. K. Wong, M. S. Rissland, D. M. Madagan, and K. N. Jones, “A Scoping Review of Physical Activity in People With Lower-Limb Loss: 10,000 Steps Per Day?,” Phys Ther, vol. 101, no. 8, Aug. 2021, doi: 10.1093/ptj/pzab115.
B. Godfrey, C. Duncan, and T. Rosenbaum-Chou, “Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users,” Arch Rehabil Res Clin Transl, vol. 4, no. 3, p. 100220, Sep. 2022, doi: 10.1016/j.arrct.2022.100220.
M. Ayabe, H. Kumahara, K. Morimura, and H. Tanaka, “Epoch length and the physical activity bout analysis: An accelerometry research issue,” 2013, doi: 10.1186/1756-0500-6-20.
“Physical activity.” Accessed: Nov. 02, 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/physical-activity
B. Godfrey, C. Duncan, and T. Rosenbaum-Chou, “Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users,” Arch Rehabil Res Clin Transl, vol. 4, no. 3, p. 100220, Sep. 2022, doi: 10.1016/J.ARRCT.2022.100220.
Gaunaurd et al., “The Utility of the 2-Minute Walk Test as a Measure of Mobility in People With Lower Limb Amputation,” Arch Phys Med Rehabil, vol. 101, no. 7, pp. 1183–1189, Jul. 2020, doi: 10.1016/j.apmr.2020.03.007.
R. S. Gailey et al., “The Amputee Mobility Predictor: An instrument to assess determinants of the lower-limb amputee’s ability to ambulate,” Arch Phys Med Rehabil, vol. 83, no. 5, pp. 613–627, May 2002, doi: 10.1053/ampr.2002.32309.
J. M. Sions, E. H. Beisheim, T. J. Manal, S. C. Smith, J. R. Horne, and F. B. Sarlo, “Differences in Physical Performance Measures among Patients with Unilateral Lower-Limb Amputations Classified as Functional Level K3 versus K4”, doi: 10.1016/j.apmr.2017.12.033.
H. R. Batten, S. M. McPhail, A. M. Mandrusiak, P. N. Varghese, and S. S. Kuys, “Gait speed as an indicator of prosthetic walking potential following lower limb amputation,” Prosthet Orthot Int, vol. 43, no. 2, pp. 196–203, Apr. 2019, doi: 10.1177/0309364618792723/ASSET/IMAGES/LARGE/10.1177_0309364618792723-FIG2.JPEG.
E. Russell Esposito, D. J. Stinner, J. R. Fergason, and J. M. Wilken, “Gait biomechanics following lower extremity trauma: Amputation vs. reconstruction,” Gait Posture, vol. 54, pp. 167–173, May 2017, doi: 10.1016/J.GAITPOST.2017.02.016.
M. Boonstra, V. Fidler, and W. H. Eisma, “Walking speed of normal subjects and amputees: Aspects of validity of gait analysis,” http://dx.doi.org/10.3109/03093649309164360, vol. 17, no. 2, pp. 78–82, Aug. 1993, doi: 10.3109/03093649309164360.
