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Gait Analysis in Individuals with Transtibial Amputation Walking on Sand

Comparing Everyday Prosthesis with a Water-Activity Prosthesis

van den Berg, Maayken E.L., PhD; Barr, Christopher J., PhD; Cavenett, Sally, MClinSc; Crotty, Maria, MD, PhD

JPO: Journal of Prosthetics and Orthotics: April 3, 2019 - Volume Online First - Issue - p
doi: 10.1097/JPO.0000000000000266
Original Research Article: PDF Only

Introduction This exploratory descriptive case-control study examined gait characteristics during sand walking in people with unilateral transtibial amputation, comparing patterns between everyday prosthesis with shoe, everyday prosthesis without shoe (EPWS), and a water-activity prosthesis (WAP), and evaluated how users experience the use of the WAP.

Materials and Methods Three-dimensional gait analysis, using an eight-camera Vicon motion capture system, was completed for 16 participants (mean age, 51.4 ± 5.5; 75% male, amputation etiology 63% trauma) when walking independently over level ground (baseline) and sand (gait adaptation response). Outcome variables were spatiotemporal data and kinematic data for the hip, knee, and ankle, and additionally, a purposefully designed Water Activity Prosthesis Survey was completed.

Results The results demonstrated cautious gait with reduced walking speed (P < 0.05) and decreased ankle range of motion (<0.05) in the prosthetic limb when walking with the EPWS and WAP. Using the WAP resulted in most prominent kinematic adaptational changes on sand. When comparing differences between the EPWS and WAP, significantly less hip extension (−2.92°; 95% confidence interval, −5.56 to −0.28; P = 0.02) and significantly less movement at the ankle (P < 0.05) occurred in the prosthetic limb in walking trials with the WAP. Nevertheless, more than 80% of the participants used the WAP at least twice a week for shower, pool, and beach activities.

Conclusions This study suggests that, although important for participation in ADL and leisure activities and supporting higher quality of life, the use of the WAP leads to unfavorable biomechanical gait alterations. Therefore, when prescribing the WAP, this trade-off should be taken into consideration.

MAAYKEN E.L. VAN DEN BERG, PhD; and MARIA CROTTY, MD, PhD are affiliated with Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.

CHRISTOPHER J. BARR, PhD, is affiliated with Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.

SALLY CAVENETT, MClinSc, is affiliated with Orthotics and Prosthetics South Australia, SA Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.

Correspondence to: Maayken E.L. van den Berg, Department of Rehabilitation, Aged and Extended Care, Flinders Medical Centre, Rehabilitation and Palliative Care Bldg, L4 Flinders Dr, Bedford Park, Adelaide, SA 5042 Australia; email:

Disclosure: The authors declare no conflict of interest.

© 2019 by the American Academy of Orthotists and Prosthetists.