Advertisement

Cross slope gait biomechanics for individuals with and without a unilateral transtibial amputation

      Highlights

      • Gait adaptations during cross-slopes were primarily in the lower extremities.
      • Gait adaptations were largely similar for those with and without a transtibial amputation.
      • An asymmetric gait may help to minimize upper body motion during cross-slopes.

      Abstract

      Background

      This research was conducted to better understand compensatory strategies during cross-slope walking for adults with and without a unilateral transtibial amputation.

      Methods

      Fourteen individuals with unilateral transtibial amputation and 14 individuals with no lower limb amputation participated in this study. Motion and force data were captured while participants walked on a treadmill in a virtual reality environment for level and ± 5° cross slopes. Temporal-spatial parameters, kinematics (ankle, knee, hip, pelvis, trunk), and ground reaction forces were examined.

      Findings

      Compared to level, participants had similar step width but slightly longer steps for top-cross-slope and slightly shorter steps for bottom-cross-slope. Top-cross-slope required a more flexed limb with ankle eversion, and bottom-cross-slope required a more extended limb with ankle inversion. Participants had similar lateral pelvis and trunk motion for all walking conditions, but slightly more anterior trunk lean for top cross-slope with more anterior trunk lean observed for individuals with a lower limb amputation than without lower limb amputation. Participants with a lower limb amputation compensated for limited prosthetic ankle-foot dorsiflexion on the top-cross-slope by increasing prosthetic side hip flexion, reducing intact ankle/knee flexion, and increasing intact push-off force.

      Interpretation

      Gait adaptations during cross-slope walking were primarily in the lower extremities and were largely similar for those with and without a transtibial amputation. The information presented in this paper provides a better understanding of gait strategies adopted during cross-slope walking and can guide researchers and industry in prosthetic development.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Altenburg B.
        • Ernst M.
        • Maciejasz P.
        • Schmalz T.
        • Braatz F.
        • Gerke H.
        • Bellmann M.
        Effects of a prosthetic foot with increased coronal adaptability on cross-slope walking.
        Can Prosthet Orthot J. 2021; 4https://doi.org/10.33137/cpoj.v4i1.35206
        • Breloff S.P.
        • Wade C.
        • Waddell D.E.
        Lower extremity kinematics of cross-slope roof walking.
        Appl. Ergon. 2019; 75: 134-142
        • Damavandi M.
        • Dixon P.C.
        • Pearsall D.J.
        Kinematic adaptations of the hindfoot, forefoot, and hallux during cross-slope walking.
        Gait Posture. 2010; 32: 411-415
        • Damavandi M.
        • Dixon P.C.
        • Pearsall D.J.
        Ground reaction force adaptations during cross-slope walking and running.
        Hum. Mov. Sci. 2012; 31: 182-189
        • Dillon M.P.
        • Major M.J.
        • Kaluf B.
        • Balasanov Y.
        • Fatone S.
        Predict the Medicare functional classification level (K-level) using the amputee mobility predictor in people with unilateral transfemoral and transtibial amputation: a pilot study.
        Prosthetics Orthot. Int. 2018; 42: 191-197
        • Dixon P.C.
        • Pearsall D.J.
        Gait dynamics on a cross-slope walking surface.
        J. Appl. Biomech. 2010; 26: 17-25
        • Domone S.
        • Lawrence D.
        • Heller B.
        • Hendra T.
        • Mawson S.
        • Wheat J.
        Optimal fall indicators for slip induced falls on a cross-slope.
        Ergonomics. 2016; 59: 1089-1099
        • Elliott R.
        Determining the lateral stability of persons walking on cross-sloped surfaces with backpacks loaded at various levels.
        J. Ergon. 2016; 6: 2
        • Gailey R.
        • Allen K.
        • Castles J.
        • Kucharik J.
        • Roeder M.
        Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use.
        J. Rehabil. Res. Dev. 2008; 45
        • Gates D.H.
        • Dingwell J.B.
        • Scott S.J.
        • Sinitski E.H.
        • Wilken J.M.
        Gait characteristics of individuals with transtibial amputations walking on a destabilizing rock surface.
        Gait Posture. 2012; 36: 33-39
        • Gholizadeh H.
        • Lemaire E.D.
        • Sinitski E.H.
        Transtibial amputee gait during slope walking with the unity suspension system.
        Gait Posture. 2018; 65: 205-212
        • Michaud S.B.
        • Gard S.A.
        • Childress D.S.
        A preliminary investigation of pelvic obliquity patterns during gait in persons with transtibial and transfemoral amputation.
        J. Rehabil. Res. Dev. 2000; 37: 1-10
        • Nicolaou M.
        Gait Adaptations to Transverse Slopes.
        McGill University, 2001
        • Pillet H.
        • Drevelle X.
        • Bonnet X.
        • Villa C.
        • Martinet N.
        • Sauret C.
        • Bascou J.
        • Loiret I.
        • Djian F.
        • Rapin N.
        APSIC: training and fitting amputees during situations of daily living.
        Irbm. 2014; 35: 60-65
        • Sinitski E.H.
        Transtibial Amputee and Able-Bodied Walking Strategies for Maintaining Stable Gait in a Multi-Terrain Virtual Environment.
        Université d’Ottawa/University of Ottawa, 2014
        • Sinitski E.H.
        • Lemaire E.D.
        • Baddour N.
        • Besemann M.
        • Dudek N.L.
        • Hebert J.S.
        Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment.
        Gait Posture. 2015; 41: 568-573
        • Sinitski Emily
        • Lemaire Edward
        • Baddour Natalie
        • Besemann Markus
        • Dudek Nancy
        • Hebert Jacqueline
        Maintaining stable transtibial amputee gait on level and simulated uneven conditions in a virtual environment.
        Disabil. Rehabilitation. Assist. Technol. 2021; 16: 40-48https://doi.org/10.1080/17483107.2019.1629186
        • Steudel-Numbers K.
        • Weaver T.D.
        Froude number corrections in anthropological studies.
        Am. J. Phys. Anthropol.: Off. Public. Am. Assoc. Phys. Anthropol. 2006; 131: 27-32
        • Thibault G.
        • Gholizadeh H.
        • Sinitski E.
        • Baddour N.
        • Lemaire E.D.
        Effects of the unity vacuum suspension system on transtibial gait for simulated non-level surfaces.
        PLoS One. 2018; 13e0199181
        • Villa C.
        • Loiret I.
        • Langlois K.
        • Bonnet X.
        • Lavaste F.
        • Fodé P.
        • Pillet H.
        Cross-slope and level walking strategies during swing in individuals with lower limb amputation.
        Arch. Phys. Med. Rehabil. 2017; 98: 1149-1157
        • Young P.M.M.
        • Wilken J.M.
        • Dingwell J.B.
        Dynamic margins of stability during human walking in destabilizing environments.
        J. Biomech. 2012; 45: 1053-1059
        • Zeni Jr., J.A.
        • Richards J.G.
        • Higginson J.S.
        Two simple methods for determining gait events during treadmill and overground walking using kinematic data.
        Gait Posture. 2008; 27: 710-714