Cross-Slope and Level Walking Strategies During Swing in Individuals With Lower Limb Amputation

Abstract Objective To quantitatively analyze prosthetic limb swing phase gait strategies used to adapt to cross slopes compared with flat surfaces. Design Cross-sectional study. Setting Gait laboratory. Participants A volunteer sample (N=49) of individuals with transfemoral amputation (n=17), individuals with transtibial amputation (n=15), and able-bodied individuals (n=17). Interventions Participants walked on flat and 6° (10%) inclined cross-slope surfaces at a self-selected walking speed. Main Outcome Measures Gait speed, step width, sagittal plane kinematics (ankle, knee, hip) on the prosthetic side during swing (uphill limb) and on the contralateral side during stance (downhill limb), frontal plane pelvic kinematics on the prosthetic side during swing, contralateral side ankle power during stance, and timing of gait events. Results All groups reduced gait speed and downhill limb knee flexion during the stance phase. Able-bodied participants adjusted their uphill limb ankle flexion during the swing phase. Participants with lower limb amputation used additional adjustments during the swing phase of the prosthetic limb when positioned uphill on cross slopes. Transtibial amputee participants mainly adapted with increased flexion of the residual hip and knee joints. Transfemoral amputee participants primarily compensated using increased pelvic hiking and vaulting gait strategies. Conclusions The swing phase of the uphill limb during cross-slope walking results in compensatory mechanisms that should be addressed during rehabilitation to gain confidence and reduce avoidance when encountering cross slopes in daily life.