Gait initiation in lower limb amputees

Objective To study limitations in function and adjustment strategies in lower limb amputees during gait initiation. Design Observational cohort study. Setting University Medical Center. Participants Amputees with a unilateral transfemoral or transtibial amputation, and able-bodied subjects. Main outcome measures Leading limb preference, temporal variables, ground reaction forces, and centre of pressure shift. Results Amputees 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. Conclusion Since 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.