The 3-D motion of the centre of gravity of the human body during level walking. II. Lower limb amputees

Objective. To analyse the motion of the centre of gravity (CG) of the body during gait in unilateral lower limb amputees with good kinematic patterns. Design. Three transtibial (below-knee, BK) and four transfemoral (above-knee, AK) amputees were required to perform successive walks over a 2.4 m long force plate, at freely chosen cadence and speed. Background. In previous studies it has been shown that in unilateral lower limb amputee gait, the motion of the CG can be more asymmetric than might be suspected from kinematic analysis. Methods. The mechanical energy changes of the CG due to its motion in the vertical, forward and lateral direction were measured. Gait speed ranged 0.75–1.32 ms−1 in the different subjects. This allowed calculation of (a) the positive work done by muscles to maintain the motion of the CG with respect to the ground (‘external’ work, Wext) and (b) the amount of the pendulum-like, energy-saving transfer between gravitational potential energy and kinetic energy of the CG during each step (percent recovery, R). Step length and vertical displacement of the CG were also measured. Results. The recorded variables were kept within the normal limits calculated in a previous work, when an average was made of the steps performed on the prosthetic (P) and on the normal (N) limb. Asymmetries were found, however, between the P and the N step. In BK amputees, the P step R was 5% greater and Wext was 21% lower than in the N step; in AK amputees, in the P step R was 54% greater and Wext was 66% lower than in the N step. Asymmetries were also found in the relative magnitude of the external work provided by each lower limb during the single stance as compared with the double stance: a marked deficit of work occurred at the P to N transition. Relevance In either BK or AK, amputees during gait may conceal severe overlaoding of the healthy lower limb and underloading of the prosthetic lower limb, despite a good kinematics. The power provided by the prosthetic limb is minimal. The reduction of these ergometric asymmertries might be porposed as an index of effectiveness of the prosthetic treatment.