Impact of amputation level on gait disorders in transfemoral and transtibial amputees.

Question: How does the level of lower limb amputation affect spatiotemporal gait asymmetry and cautious gait criteria to inform tailored rehabilitation interventions?

Design: A retrospective study analyzing gait patterns in individuals with unilateral lower limb amputations.

Participants: 49 amputees (22 (45 %) transtibial, 27 (55 %) transfemoral) compared to 30 healthy controls, evaluated between January 2018 and June 2023. INTERVENTION PARTICIPANTS: performed a spontaneous walking speed test on a pressure mat (Zebris® FDM 2 & 3 System, 100 Hz, v 1.18.44, GmbH, Isny, Germany) after completing rehabilitation.

Outcome Measures: Gait symmetry and cautious gait were assessed using spatio-temporal parameters, center of pressure (CoP) displacement, and foot segment forces.

Results: Increased asymmetry was observed in stance phase duration, step length, stance duration, and walking speed (95 % CI 0.398-0.658) depending on the level of amputation. Transfemoral amputees showed significant increases in step width (95 % CI 0.201-0.512), double support phase (95 % CI 0.000-0.150), and medio-lateral CoP displacement (95 % CI 0.039-0.326). The increased asymmetry in spatio-temporal parameters suggests different compensation strategies between transfemoral and transtibial levels. These differences highlight the importance of the rehabilitation paradigm in managing asymmetry and its underlying compensations during locomotor activities.

Conclusion: The level of amputation significantly impacts gait asymmetry and cautious gait parameters. Transfemoral amputees exhibit more pronounced cautious gait characteristics, likely due to the need for greater stabilization. These findings underscore the importance of personalized rehabilitation to address specific compensations and gait abnormalities based on amputation level.