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Differences in the Spatiotemporal Parameters of Transtibial and Transfemoral Amputee Gait

Highsmith, M Jason DPT, CP, FAAOP; Schulz, Brian W. PhD; Hart-Hughes, Stephanie PT, MSMS, NCS; Latlief, Gail A. DO, FAAPMR; Phillips, Sam L. PhD, CP, FAAOP

JPO: Journal of Prosthetics and Orthotics: January 2010 - Volume 22 - Issue 1 - p 26-30
doi: 10.1097/JPO.0b013e3181cc0e34
Article

Lower limb amputees have less efficient gait patterns that may in part be due to spatiotemporal asymmetries. Transfemoral (TF) amputees are believed to have greater gait asymmetries than transtibial (TT) amputees, but this has not been clearly established. The purpose of this study was to determine the effects of amputation level on step length, width, and time for prosthetic and sound legs. Other spatiotemporal gait parameters of this subject cohort were also reported. Subjects traversed a GaitRite walkway 10 times at their habitual walking speed. Step length, width, and time were selected a priori to compare by amputation level and between sound and prosthetic sides. In addition, a degree of asymmetry (DoA) was calculated and tested for each of these three parameters. This is a cross-sectional/observational study with 15 community ambulating, unilateral lower limb amputees (seven with TT and eight with TF amputation). Prosthetic and sound sides averaged together, TF amputees utilized shorter (62.2 ± 7.0 cm vs. 72.1 ± 7.1 cm, p = 0.0007) and wider (20.7 ± 4.2 cm vs. 15.4 ± 3.1 cm, p = 0.0008) steps that were of longer duration (0.65 ± 0.8 seconds vs. 0.59 ± 0.04 seconds, p = 0.009) than those of TT amputees. The DoA analysis indicated that TF amputee step times were more asymmetrical than those of TT amputees (DoA = −0.08 ± 0.05 vs. 0.01 ± 0.04, p = 0.0008). TF amputees walk with greater temporal, but not spatial, asymmetry than TT amputees.

Transfemoral amputees are believed to have greater gait asymmetries than transtibial amputees, but this has not been clearly established. The purpose of this study was to determine the effects of amputation level on step length, width, and time for prosthetic and sound legs. Other spatiotemporal gait parameters of this subject cohort were also reported. The study found that transfemoral amputees walk with significantly greater temporal, but not spatial, asymmetry than transtibial amputees due to their prosthetic leg spending a greater percentage of its gait cycle in swing phase and a smaller percentage in stance phase.

M. JASON HIGHSMITH, DPT, CP, FAAOP, is affiliated with Veterans' Administration HSR&D/RR&D Center of Excellence, Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Medical Center; and University of South Florida, School of Physical Therapy & Rehabilitation Sciences, College of Medicine, Tampa, Florida.

BRIAN W. SCHULZ, PhD, is affiliated with Veterans' Administration HSR&D/RR&D Center of Excellence, Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Medical Center, Tampa, Florida.

STEPHANIE HART-HUGHES, PT, MSMS, NCS, is affiliated with Veterans' Administration HSR&D/RR&D Center of Excellence, Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Medical Center, Tampa, Florida.

GAIL A. LATLIEF, DO, FAAPMR, is affiliated with Veterans' Administration HSR&D/RR&D Center of Excellence, Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Medical Center; and University of South Florida, College of Medicine, Tampa, Florida.

SAM L. PHILLIPS, PhD, CP, FAAOP, is affiliated with Veterans' Administration HSR&D/RR&D Center of Excellence, Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Medical Center, Tampa, Florida.

Disclosure: The authors declare no conflict of interest.

This study was supported by a VA HSR&D Polytrauma QUERI at the James A. Haley V.A. Medical Center.

Correspondence to: M. Jason Highsmith, DPT, CP, FAAOP, University of South Florida, College of Medicine, School of Physical Therapy & Rehabilitation Sciences, 12901 Bruce B. Downs Blvd. MDC 077, Tampa, FL 33612-4799; e-mail: mhighsmi@health.usf.edu

© 2010 American Academy of Orthotists & Prosthetists