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Gait Posture 2022 06 6;95:76-83. Epub 2022 Apr 6.

Grupo Rehabilitación en Salud, Sede de Investigación Universitaria, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Mahavir Kmina Artificial Limb Center, Carrera 54 No. 79 AA Sur 40, Bodegas La Troja, Local 116, La Estrella, Colombia.

Background: Lower limb prosthetic alignment is a procedure mostly subjective. A prosthetic misaligned induces gait deviations and long-term joint diseases. The alignment effects for each lower limb and the stump stays uncertain. Read More

Clin Biomech (Bristol, Avon) 2022 Apr 25;94:105632. Epub 2022 Mar 25.

Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, 110 Totman Building, Amherst, MA 01003-9258, United States; School of Kinesiology, University of Michigan, SKB 1210, 830 North University, Ann Arbor, MI 48109-1048, United States. Electronic address:

Background: People with unilateral amputation typically walk with greater metabolic cost than able-bodied individuals, while preferring asymmetric walking characteristics. It is unclear if asymmetric walking is energetically optimal and how metabolic cost accounts for asymmetric patterns in people with amputation. The purpose of this study was to determine the effects of stance-time asymmetry on the metabolic cost of transport. Read More

J Neuroeng Rehabil 2022 Mar 23;19(1):33. Epub 2022 Mar 23.

Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.

Background: Individuals with unilateral transfemoral amputation are prone to developing health conditions such as knee osteoarthritis, caused by additional loading on the intact limb. Such individuals who can run again may be at higher risk due to higher ground reaction forces (GRFs) as well as asymmetric gait patterns. The two aims of this study were to investigate manipulating step frequency as a method to reduce GRFs and its effect on asymmetric gait patterns in individuals with unilateral transfemoral amputation while running. Read More

Arch Phys Med Rehabil 2022 Mar 13. Epub 2022 Mar 13.

Northwestern University, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois; Research and Development Office, Jesse Brown VA Medical Center, Chicago, Illinois; Northwestern University, Department of Biomedical Engineering, McCormick School of Engineering, Evanston, Illinois, United States.

Objective: To compare gait biomechanics of the Northwestern University Flexible Sub-Ischial Vacuum (NU-FlexSIV) Socket to the ischial containment (IC) socket.

Design: Randomized crossover trial with 2, 7-week periods.

Setting: Private prosthetic clinics and university research laboratory. Read More

Clin Rehabil 2022 Jul 7;36(7):857-872. Epub 2022 Mar 7.

Department of Kinesiology and Community Health, College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.

Objective: To investigate the effectiveness of exercise interventions to improve gait and balance in individuals with lower limb amputations.

Methods: A systematic search was conducted on the PubMed, Scopus, Web of Science, SPORTDiscuss, and CINAHL databases until January 2022. Only randomized control trials that evaluated adults (>18 years old) with lower limb amputations and compared any exercise intervention with a traditional prosthetic training were included in the study. Read More

Unfallchirurg 2022 Apr 25;125(4):266-274. Epub 2022 Feb 25.

Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland.

Background: After transfemoral amputation a prosthesis is required to restore autonomous standing and bipedal locomotion. Attachment of the prosthesis can be achieved either classically via socket suspension with a shaft in the stump or directly via implantation of an intramedullary transcutaneous femoral prosthesis (osseointegrated prosthesis).

Aim: A fully instrumented gait analysis should enable objectification of the anticipated advantages of the EEP with respect to the gait pattern and individual mobility. Read More

Foot Ankle Orthop 2021 Oct 28;6(4):24730114211050366. Epub 2021 Oct 28.

Department of Kinesiology, Laval University, Quebec City, Quebec, Canada.

Background: The 6-minute walk test (6MWT) is one of the common clinical tests to assess rehabilitation progress and needs in individuals with lower-limb amputation (iLLAs). However, the analysis of this test is mostly limited to the distance parameter. The first aim was to investigate effort intensity and spatiotemporal parameters of 6MWT in iLLAs using inertial measurement units (IMUs) and heart rate (HR) monitor, and second, to assess physical, physiological, and pain-related aspects of fatigue over 6MWT. Read More

J Appl Biomech 2021 10 9;37(5):440-449. Epub 2021 Sep 9.

Laval University.

Inertial measurement units and normative values enable clinicians to quantify clinical walking tests and set rehabilitation goals. Objectives of this study were (1) to compare time- and distance-based walking tests in individuals with lower limb amputation (iLLA) and normative values following rehabilitation discharge (T1) and 6 weeks after discharge (T2) and (2) to investigate spatiotemporal and foot kinematic parameters over a 6-minute walk test using inertial measurement units. Twelve iLLA participated in this study. Read More

Acta Chir Plast 2021 ;63(2):46-51

Background: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. Read More

Sensors (Basel) 2021 Jul 23;21(15). Epub 2021 Jul 23.

Healthcare Innovation Centre, School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK.

Sensor systems to measure pressure at the stump-socket interface of transfemoral amputees are receiving increasing attention as they allow monitoring to evaluate patient comfort and socket fit. However, transfemoral amputees have many unique characteristics, and it is unclear whether existing research on sensor systems take these sufficiently into account or if it is conducted in ways likely to lead to substantial breakthroughs. This investigation addresses these concerns through a scoping review to profile research regarding sensors in transfemoral sockets with the aim of advancing and improving prosthetic socket design, comfort and fit for transfemoral amputees. Read More

Gait Posture 2021 10 2;90:9-15. Epub 2021 Aug 2.

Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, 50-367, Wrocław, Poland.

Background: Prostheses can help persons with trans-femoral amputation (TFA) regain normal function, but such individuals still exhibit gait deviations expressed in gait asymmetries. We apply a specialised tool, the Symmetry Function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables and to identify areas with large side deviations (exceeding defined ±5% threshold) in the movement cycle.

Research Question: Which movements and joints or GRF components revealed the most significant side deviations in the movement cycle? When exactly are they located in the gate cycle?

Methods: In this retrospective observational study, an instrumented motion analysis system was used to register the gait of fourteen patients after unilateral TFA. Read More

Adv Wound Care (New Rochelle) 2021 09 4;10(9):529-533. Epub 2019 Dec 4.

Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois.

Residual limb wounds or ulcers are one of the most frequent skin problems reported by lower extremity prosthesis users. Healing often requires prosthesis disuse, which can logically impair physical functioning. However, there are limited data available to support this idea. Read More

J Neuroeng Rehabil 2021 07 3;18(1):111. Epub 2021 Jul 3.

The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Pisa, Italy.

Background: Transfemoral amputation is a serious intervention that alters the locomotion pattern, leading to secondary disorders and reduced quality of life. The outcomes of current gait rehabilitation for TFAs seem to be highly dependent on factors such as the duration and intensity of the treatment and the age or etiology of the patient. Although the use of robotic assistance for prosthetic gait rehabilitation has been limited, robotic technologies have demonstrated positive rehabilitative effects for other mobility disorders and may thus offer a promising solution for the restoration of healthy gait in TFAs. Read More

Prosthet Orthot Int 2021 Jun;45(3):198-204

WestMARC, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.

Background: The Scottish Specialist Prosthetics Service has provided microprocessor knees (MPKs) through the National Health Service since 2014, predominantly to high-activity transfemoral amputations (TFAs). Benefits of MPKs to the lower-activity TFA are less established in the literature.

Objectives: This study aimed to compare patient-reported and functional measures in low-activity TFAs transitioning from a mechanical knee to a MPK. Read More

J Reconstr Microsurg 2021 Nov 31;37(9):728-734. Epub 2021 Mar 31.

Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.

Background:  Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. Read More

Arthroplast Today 2021 Apr 26;8:46-52. Epub 2021 Feb 26.

Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Background: Extensor mechanism disruption (EMD) combined with periprosthetic joint infection (PJI) after total knee arthroplasty are life-changing complications. The literature suggests many eventually receive above-knee amputation and lose ambulatory function. An alternative is modular knee fusion (KF), but little is known about its outcomes and biomechanical function. Read More

Gait Posture 2022 02 19;92:493-497. Epub 2021 Feb 19.

Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Rehabilitation Medicine, Uniformed Service University of the Health Sciences, Bethesda, MD, USA; Research & Surveillance Division, DoD-VA Extremity Trauma & Amputation Center of Excellence, USA. Electronic address:

Background: Trunk postural control (TPC) is critical in maintaining balance following perturbations (i.e., avoiding falls), and impaired among persons with lower extremity trauma, contributing to elevated fall risk. Read More

J Neuroeng Rehabil 2021 01 19;18(1). Epub 2021 Jan 19.

Department of Physiotherapy, Wroclaw Medical University, Grunwaldzka 2, 50-355, Wroclaw, Poland.

Background: Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). Read More

J Long Term Eff Med Implants 2020 ;30(4):267-273

P.N. Soukakos Orthopaedic Research and Education Center, Sylvia Ioannou Biomechanics and Gait Analysis Laboratory, Attikon University Hospital, First Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Open calcaneal fractures with extensive bone loss and severe soft tissues injuries are very rare. There is no treatment protocol for these severe injuries. The incidence of infection, osteomyelitis, and amputation is high compared to closed calcaneal fractures. Read More

IEEE Trans Neural Syst Rehabil Eng 2020 12 28;28(12):2890-2900. Epub 2021 Jan 28.

The loss of somatosensory feedback after transfemoral amputation imposes a serious challenge in achieving postural stability. In the recent past, weight shifting exercises with fixed ankle joint have been reported useful in boosting the limit of stability (LOS) only in the sound limb; the LOS on the prosthetic limb did not improve. A fixed ankle joint restricts movement in the anterior-posterior direction at the ankle level. Read More

J Neuroeng Rehabil 2020 10 8;17(1):134. Epub 2020 Oct 8.

Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, (898) P.O. Box 9101, NL-6500 HB, Nijmegen, The Netherlands.

Background: After transfemoral amputation, many hours of practice are needed to re-learn walking with a prosthesis. The long adaptation process that consolidates a novel gait pattern seems to depend on cerebellar function for reinforcement of specific gait modifications, but the precise, step-by-step gait modifications (e.g. Read More

Clin Biomech (Bristol, Avon) 2020 12 7;80:105102. Epub 2020 Jul 7.

University of Colorado, Department of Physical Medicine and Rehabilitation, United States of America; Eastern Colorado Geriatric Research Education and Clinical Center, United States of America. Electronic address:

Background: Movement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown.

Methods: Kinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Read More

Clin Biomech (Bristol, Avon) 2020 12 31;80:105141. Epub 2020 Jul 31.

Center for Limb Loss and MoBility VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA. Electronic address:

Background: Prosthetic feet are available in a range of stiffness categories, however, there is limited evidence to guide optimal selection during prosthetic foot prescription. The aim of this study was to determine the effect of commercial prosthetic foot stiffness category on foot-ankle biomechanics, gait symmetry, community ambulation, and relative foot stiffness perception.

Methods: Participants were fit in randomized order with three consecutive stiffness categories of a commonly-prescribed prosthetic foot. Read More

Am J Phys Med Rehabil 2020 11;99(11):1067-1071

From the Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada (GC, HO, EM, CF, SWH); Department of Physical Medicine & Rehabilitation, Parkwood Institute, London, Ontario, Canada (RV, MWP); Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada (RV, MWP, SWH); and School of Physical Therapy, University of Western Ontario, London, Ontario, Canada (SWH).

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Read More

Gait Posture 2020 07 31;80:162-167. Epub 2020 May 31.

Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States. Electronic address:

Background: Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. Read More

Ann Phys Rehabil Med 2021 Jan 26;64(1):101395. Epub 2020 Aug 26.

Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.

Background: Previous work has highlighted the highly functional post-rehabilitation level of military individuals who sustained traumatic amputation. Understanding how these individuals walk with their prosthesis could be key to setting a precedent for what is realistically possible in the rehabilitation of individuals with amputations.

Objective: The aim of this paper is to answer how "normal" should the gait of an individual with an amputation(s) be and can we aspire to mimic able-bodied gait with the most advanced prosthetics in highly functioning individuals?

Methods: This was a cross-sectional study comparing the gait of severely injured and highly functional UK trans-tibial (n=10), trans-femoral (n=10) and bilateral trans-femoral (n=10) military amputees after completion of their rehabilitation programme to that of able-bodied controls (n=10). Read More

Mil Med 2020 01;185(Suppl 1):480-489

Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD 20817.

Introduction: The objective was to determine if the Mobile Device Outcomes-based Rehabilitation Program (MDORP) improved strength, mobility, and gait quality in service members (SMs) and Veterans with lower limb amputation (LLA).

Methods: Seven SMs and 10 Veterans with LLA enrolled and were trained to use a mobile sensor system, called Rehabilitative Lower Limb Orthopedic Analysis Device (ReLOAD). ReLOAD provided participants with real-time assessment of gait deviations, subsequent corrective audio feedback, and exercise prescription for normalizing gait at home and in the community. Read More

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:5382-5385

People with a transtibial amputation worldwide rely on their prosthetic socket to regain their mobility. Patient comfort is largely affected by the weight and strength of these prosthetic sockets. The use of additive manufacturing could give the prosthetist a range of new design possibilities when designing a prosthetic socket. Read More

Injury 2020 May 11;51 Suppl 2:S90-S96. Epub 2019 Nov 11.

Institute for Biomechanics, BG Klinikum Murnau, Germany; Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.

Movement or gait analysis has become a viable assessment tool not only used in sports science or basic biomechanical research, but has also expanded to be a very valuable instrument in clinical diagnostics, monitoring functional recovery and musculoskeletal rehabilitation. In this context, this method has long been an integral part solely in neurological disorders such as cerebral palsy. However, in the meantime the benefits have also become apparent in other medical areas, such as foot surgery, orthopaedic technology, or in patients after lower limb amputation. Read More

J Neuroeng Rehabil 2019 11 6;16(1):132. Epub 2019 Nov 6.

Department of Engineering, University Roma TRE, Roma, Italy.

Background: The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects. Read More