Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. Design: Prospective and descriptive study. Subjects: Fourteen subjects with a recent transfemoral, knee disarticulation or transtibial amputation. Methods: Subjects stepped over an obstacle and initiated and terminated gait at four different times during the rehabilitation process. Outcome measures: Success rate, gait velocity and lower limb joint angles in obstacle crossing, centre of pressure shift and peak anteroposterior ground reaction force in gait initiation and termination. Results: In obstacle crossing amputees increased success rate, gait velocity and swing knee flexion of the prosthetic limb. Knee flexion in transfemoral and knee disarticulation amputees was not sufficient for safe obstacle crossing, which resulted in a circumduction strategy. In gait initiation and termination amputees increased the anteroposterior ground reaction force and the centre of pressure shift in the mediolateral direction in both tasks. Throughout the rehabilitation process the centre of pressure was shifted anteriorly before single-limb stance on the trailing prosthetic limb in gait initiation, whereas in gait termination the centre of pressure in single-limb stance remained posterior when leading with the prosthetic limb. Conclusion: Subjects with a recent amputation develop adjustment strategies to improve obstacle crossing, gait initiation and gait termination. Innovations in prosthetic design or training methods may ease the learning process of these tasks.