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Evolution of vaulting strategy during locomotion of individuals with transfemoral amputation on slopes and cross-slopes compared to level walking

Article dans une revue avec comité de lecture
Author
VILLA, Coralie
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
DREVELLE, Xavier
564850 Institution Nationale des Invalides - Centre d’Etudes et de Recherche sur l’Appareillage des Handicapés [INI/CERAH]
BONNET, Xavier
1043694 Proteor
LAVASTE, François
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
LOIRET, Isabelle
268037 Institut Régional de Médecine Physique et de Réadaptation Louis Pierquin [Nancy] [IRR Louis Pierquin]
FODÉ, Pascale
564850 Institution Nationale des Invalides - Centre d’Etudes et de Recherche sur l’Appareillage des Handicapés [INI/CERAH]
PILLET, Hélène
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]

URI
http://hdl.handle.net/10985/20917
DOI
10.1016/j.clinbiomech.2015.03.022
Date
2015
Journal
Clinical Biomechanics

Abstract

Background: Vaulting is a walking strategy qualitatively characterized in clinics by the sound ankle plantiflexion in midstance to assist prosthetic foot clearance. Even though potentially harmful, this strategy is often observed among people with transfemoral amputation to secure clearance of the prosthetic limb during swing phase. The aim of the study is to provide a quantitative analysis of the evolution of the vaulting strategy in challenging situations of daily living. Methods: 17 persons with transfemoral amputation and 17 able-bodied people participated in the study. Kinematic and kinetic gait analyses were performed for level walking, 10% inclined cross-slope walking, 5% and 12% inclined slope ascending. To study vaulting strategy, peak of generated power at the sound ankle at midstance was identified and quantified in the different walking situations. In particular, values were compared to a vaulting threshold corresponding to a peak of generated power superior to 0.15 W/kg. Findings: The vaulting threshold was exceeded for a larger proportion of people with amputation during crossslope locomotion and slope ascent than during level walking. In addition, magnitude of the peak of generated power increased significantly compared to level walking in these situations. Interpretation: Vaulting seems to be widely used by patients with transfemoral amputation in daily living situations. The number of patients using vaulting increased with the difficulty of the walking situation. Results also suggested that patients could dose the amount of vaulting according to gait environment to secure prosthetic toe clearance. During rehabilitation, vaulting should also be corrected or prevented in daily living tasks.

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