Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.

Effects of walking speed on magnitude and symmetry of ground reaction forces in individuals with transfemoral prosthesis.

Individuals with unilateral transfemoral amputation (uTFA) walk asymmetrically. Investigating gait symmetry in ground reaction force (GRF) is critical because asymmetric loading on the residual limb can result in injury. The aim of this study was to investigate the GRF of individuals with uTFA by systematically controlling their walking at eight speeds(2.0-5.5 km/h with increments of 0.5 km/h) on a treadmill. Forty-eight individuals participated in this study, which included 24 individuals with uTFA (K3 and K4) and 24 individuals without amputation. GRFs (anteroposterior, mediolateral, and vertical) of the prosthetic and intact limb steps were collected for the individuals with uTFA and those of the right limb were collected for the control group. Peak force values of the GRF components, temporal parameters, impulses, and their asymmetry ratios were investigated and statistically analyzed. With an increasing walking speed, the magnitude of GRF changed gradually; individuals with uTFA exhibited increased GRF asymmetry in the vertical and mediolateral components, while that of the anteroposterior component remained constant. uTFA individuals typically maintained a constant asymmetry ratio in the mediolateral and anteroposterior (braking and propulsive) GRF impulses across a wide range of walking speeds. This result suggests that individuals with uTFA may cope with various walking speeds by maintaining symmetric mediolateral and anteroposterior impulses. The data provided in this study can serve as normative data for the GRF and its symmetry across a range of walking speeds in individuals with uTFA.

Inter-limb weight transfer strategy during walking after unilateral transfemoral amputation.

Although weight transfer is an important component of gait rehabilitation, the biomechanical strategy underlying the vertical ground reaction force loading/unloading in individuals with unilateral transfemoral amputation between intact and prosthetic limbs remains unclear. We investigated weight transfer between limbs at different walking speeds in 15 individuals with unilateral transfemoral amputation and 15 individuals without amputation as controls, who walked on an instrumented treadmill. The normalized unloading and loading rates were calculated as the slope of decay and rise phase of the vertical ground reaction force, respectively. We performed linear regression analyses for trailing limb's unloading rate and leading limb's loading rate between the prosthetic, intact, and control limbs. While loading rate increased with walking speed in all three limbs, the greatest increase was observed in the intact limb. In contrast to the other limbs, the prosthetic limb unloading rate was relatively insensitive to speed changes. Consequently, the regression line between trailing prosthetic and leading intact limbs deviated from other relationships. These results suggest that weight transfer is varied whether the leading or trailing limb is the prosthetic or intact side, and the loading rate of the leading limb is partially affected by the unloading rate of the contralateral trailing limb.

Anterior-posterior ground reaction forces across a range of running speeds in unilateral transfemoral amputees.

As a fundamental motor pattern, the ability to run at a range of constant speeds is a prerequisite for participating in competitive games and recreational sports. However, it remains unclear how unilateral transfemoral amputees modulate anterior and posterior ground reaction force impulses (GRFIs) in order to maintain constant running speeds. The purpose of this study was to investigate anterior and posterior GRFIs across a wide range of constant running speeds in unilateral transfemoral amputees wearing a running-specific prosthesis. Eleven runners with unilateral transfemoral amputation ran on an instrumented treadmill at 5 different speeds (30%, 40%, 50%, 60%, and 70% of the average velocity of their 100-m personal records). Anterior-posterior ground reaction forces (GRFs) were measured at 1000 Hz over 14 consecutive steps. Impulse, magnitude, and duration of anterior and posterior GRFs were compared between the affected and unaffected limbs at each speed. The net anterior-posterior GRFI, reflecting the changes in horizontal running velocity, was consistently positive (propulsion) in the affected limb and negative (braking) in the unaffected limb at all speeds. Regardless of running speed, unilateral transfemoral amputees maintain constant running speeds not over each step, but over 2 consecutive steps (i.e., one stride).

Loading rates in unilateral transfemoral amputees with running-specific prostheses across a range of speeds.

BACKGROUND: Understanding the potential risks of running-related injuries in unilateral transfemoral amputees contributes to the development and implementation of the injury prevention programme in running gait rehabilitation. We investigated the vertical ground reaction force loading in unilateral transfemoral amputees who used running-specific prostheses across a range of running speeds. METHODS: Ten unilateral transfemoral amputees and ten non-amputees performed running trials on an instrumented treadmill at the incremental speeds of 30, 40, 50, and 60% of their maximum acquired speeds. Per-step and cumulative vertical instantaneous loading rates were calculated from the vertical ground reaction force in the affected, unaffected, and non-amputated control limbs. FINDINGS: Both the per-step and cumulative vertical instantaneous loading rates of the unaffected limbs in runners with unilateral transfemoral amputation were significantly greater than the affected and non-amputated control limbs at all speeds. INTERPRETATION: The results of the present study suggest that runners with unilateral transfemoral amputation may be exposed to a greater risk of running-related injuries in their unaffected limbs compared to the affected and non-amputated control limbs.