Coralie Villa1, Xavier Drevelle2, Xavier Bonnet3, François Lavaste4, Isabelle Loiret5, Pascale Fodé2, Hélène Pillet6. 1. Institution Nationale des Invalides Centre d'Etude et de Recherche sur l'Appareillage des Handicapés, BP 50719, 57147 Woippy Cedex, France; Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 boulevard de l'Hôpital, 75013 Paris, France. Electronic address: coralie.villa@invalides.fr. 2. Institution Nationale des Invalides Centre d'Etude et de Recherche sur l'Appareillage des Handicapés, BP 50719, 57147 Woippy Cedex, France. 3. PROTEOR, 6 rue de la redoute 21250 Seurre, France. 4. Institution Nationale des Invalides Centre d'Etude et de Recherche sur l'Appareillage des Handicapés, BP 50719, 57147 Woippy Cedex, France; Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 boulevard de l'Hôpital, 75013 Paris, France. 5. Centre de médecine physique et de réadaptation Louis Pierquin IRR-UGECAM, Nord-Est 75, Boulevard Lobau, CS 34209, 54042 Nancy Cedex, France. 6. Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 boulevard de l'Hôpital, 75013 Paris, France. Electronic address: helene.pillet@ensam.eu.
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 cross-slope 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.
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 cross-slope 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.
Authors: Julian C Acasio; Iman Shojaei; Rajit Banerjee; Christopher L Dearth; Babak Bazrgari; Brad D Hendershot Journal: J Biomech Date: 2019-08-19 Impact factor: 2.712