Gait initiation in lower limb amputees

ObjectiveTo study limitations in function and adjustment strategies in lower limb amputees during gait initiation.DesignObservational cohort study.SettingUniversity Medical Center.ParticipantsAmputees with a unilateral transfemoral or transtibial amputation, and able-bodied subjects.Main outcome measuresLeading limb preference, temporal variables, ground reaction forces, and centre of pressure shift.ResultsAmputees demonstrated a decrease in peak anterior ground reaction force, a smaller or absent posterior centre of pressure shift, and a lower gait initiation velocity. The main adjustments strategies in amputees were more limb-loading on the non-affected limb, prolonging the period of propulsive force production in the non-affected limb and initiating gait preferably with the prosthetic limb.ConclusionSince an intact ankle joint and musculature is of major importance in gait initiation, functional limitations and adjustment strategies in transfemoral and transtibial amputees were similar. Improving prosthetic ankle properties and initiating gait with the prosthetic limb may facilitate the gait initiation process in amputees.