Share this article on:

Leg Laterality Differences in Persons with Bilateral Transtibial Amputation: A Pilot Study Using Prosthesis-Integrated Load Cells

Fiedler, Goeran PhD, CPO-D; Slavens, Brooke A. PhD; Hafner, Brian J. PhD; Briggs, Doug PhD; Smith, Roger O. PhD

JPO: Journal of Prosthetics and Orthotics: October 2013 - Volume 25 - Issue 4 - p 168–176
doi: 10.1097/JPO.0000000000000005
Original Research Article

ABSTRACT Rehabilitation of persons with bilateral transtibial amputation is challenged by the unavailability of a sound leg to provide stability in standing and gait. Absence of a sound limb complicates both prosthetic fitting and gait training. Little evidence related to prosthetic fitting and gait training of persons with bilateral amputation is available to guide these clinical procedures. This work addresses questions that are frequently encountered by prosthetists, including is there a disparity in leg strength or controllability between limbs and, if so, which is the favored or dominant leg? A disparity or leg laterality may have implications in the selection and adjustment of prosthetic components, prescription of rehabilitation therapies, or recommendations for the use of assistive devices. In this study, the gait of two persons with bilateral transtibial amputation was assessed using prosthesis-integrated load cells installed in both legs. The load cells provided continuous measurement of kinetic and temporal outcomes (forces and moments) measured during gait on different surfaces and on stairs. Pairwise comparisons of gait variables measured by each load cell were used to quantify leg laterality. The results of this study suggest that integrated load cells have the potential to assess leg laterality in persons with bilateral amputation and that these may be useful tools for enhancing the clinical decision-making process.

GOERAN FIEDLER, PhD, CPO-D, and BRIAN J. HAFNER, PhD, are affiliated with the University of Washington, Seattle. BROOKE A. SLAVENS, PhD; DOUG BRIGGS, PhD; and ROGER O. SMITH, PhD, are affiliated with the University of Wisconsin-Milwaukee.

Disclosure: The authors declare no conflict of interest.

This study was funded by a Student Research Grant, a Graduate Project Assistantship, provided by the University of Wisconsin–Milwaukee, College of Health Sciences, and an Advanced Rehabilitation Research Training (ARRT) Fellowship, funded by a training grant from the National Institute on Disability and Rehabilitation Research (NIDRR) and provided by the University of Washington, Seattle. Integrated load cell equipment was loaned for the duration of this study by College Park Industries (Warren, MI, USA).

Correspondence to: Goeran Fiedler, PhD, CPO-D, Department of Rehabilitation Medicine, University of Washington, Box 356490, Seattle, WA 98195-6490; email:

© 2013 by the American Academy of Orthotists and Prosthetists.