Gait adaptations of transfemoral prosthesis users across multiple walking tasks

Abstract

Background: For people with lower extremity amputations, the decreased confidence and suboptimal gait associated with dynamic instability can negatively affect mobility and quality of life. Quantifying dynamic instability could enhance clinical decision making related to lower extremity prosthetics and inform future prosthetic research.

Objective: To quantitatively examine gait adaptations in transfemoral amputees across various walking conditions.

Study design: Cross-sectional study.

Methods: Plantar-pressure data were collected from 11 individuals with unilateral transfemoral amputations using an in-shoe plantar-pressure measurement system while navigating rigid and soft ground, ramp, and stair conditions. Six parameters were examined: anterior-posterior and medial-lateral center-of-pressure direction changes, sensor cell loading frequency (cell triggering), maximum lateral force position, double support time, and stride time. Paired t-tests and analyses of variance were used to examine differences between limbs and walking conditions, respectively.

Results: Values for medial-lateral center-of-pressure direction change, sensor cell loading frequency, and double support time were significantly greater on the intact limb than the prosthetic limb. Significant differences between conditions occurred only for anterior-posterior center-of-pressure direction change and double support time on the prosthetic limb.

Conclusion: Higher values on the intact limb suggest that it plays a key role in maintaining stability and optimizing body progression during different tasks. Differences between participants, limbs, and walking condition indicate parameter sensitivity to adaptive gait strategies.

Clinical relevance: This plantar-pressure-based approach is a viable option for point-of-care evaluation of locomotor performance, across common various mobility tasks and activities of daily living. The information obtained could be valuable for prosthetic prescription and optimization of prosthetic fit and alignment, potentially improving mobility for prosthetic users with dynamic stability deficits.

Keywords: Biomechanics of prosthetic–orthotic devices; biomechanics; gait; gait analysis; plantar-pressure; prosthetics; transfemoral.