Whole limb push-off work in people with transtibial amputation during slope ascent

Abstract

Unilateral transtibial amputation impairs locomotion, especially in daily living outdoor situations. As an example, slope ascent requires specific gait adjustments such as hip power generation during single support followed by ankle power generation during second double support. Hip extensor strengthening could help peo- ple with transtibial amputation for hip propulsion in slope ascent (Langlois et al. 2014). Energy storage and return (ESAR) foot-ankle prostheses have been designed to absorb and release elastic energy in an attempt to restore some functions of the amputated limb. However, it remains unclear how ESAR feet contribute to center of mass propulsion, especially during slope ascent. Simple models were recently developed to globally analyze gait in an energetic point of view by computing the center of mass mechanical work (Donelan et al. 2002; Kuo et al. 2005). Particularly, several hypoth- eses permit to estimate for each lower limb the whole limb push-off work during double support (Kuo et al. 2005). Using this approach, step-to-step transition was investigated during level walking, in able- bodied subjects wearing prosthetic foot (Caputo & Collins 2014) and in people with transtibial and transfemoral amputation (Houdijk et al. 2009; Bonnet et al. 2014), and in slopes in able-bodied subjects (Franz et al. 2012). Up to now, no study quantified prosthetic and contralateral push-off work during slope ascent in a below-knee amputee population. Thus, the aim of the study is to investigate center of mass mechanical work adjustments during the propulsion period during slope ascent for two inclinations of slopes compared to level walking in people with transtibial amputation.