Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 6, 2017
   Pages 1089 — 1106

Abstract — The biomechanical response of persons with transfemoral amputation to variations in prosthetic knee alignment during level walking

Sara R. Koehler-McNicholas, PhD;1–3* Robert D. Lipschutz, CP;1,4 Steven A. Gard, PhD1–3

1Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; 2Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL; 3Jesse Brown VA Medical Center, Chicago, IL; 4Rehabilitation Institute of Chicago, Chicago, IL

Abstract — Prosthetic alignment is an important factor in the overall fit and performance of a lower-limb prosthesis. However, the association between prosthetic alignment and control strategies used by persons with transfemoral amputation to coordinate the movement of a passive prosthetic knee is poorly understood. This study investigated the biomechanical response of persons with transfemoral amputation to systematic perturbations in knee joint alignment during a level walking task. Quantitative gait data were collected for three alignment conditions: bench alignment, 2 cm anterior knee translation (ANT), and 2 cm posterior knee translation (POST). In response to a destabilizing alignment perturbation (i.e., the ANT condition), participants significantly increased their early-stance hip extension moment, confirming that persons with transfemoral amputation rely on a hip extensor strategy to maintain knee joint stability. However, participants also decreased the rate at which they loaded their prosthesis, decreased their affected-side step length, increased their trunk flexion, and maintained their prosthesis in a more vertical posture at the time of opposite toe off. Collectively, these results suggest that persons with transfemoral amputation rely on a combination of strategies to coordinate stance-phase knee flexion. Further, comparatively few significant changes were observed in response to the POST condition, suggesting that a bias toward posterior alignment may have fewer implications in terms of stance-phase, knee joint control.

Key words: alignment, amputation, artificial limbs, gait analysis, hip, knee, load cell, transfemoral, treadmill, trunk.


View HTML ?? View PDF ?? Contents Vol. 53, No. 6
This article and any supplementary material should be cited as follows:
Koehler-McNicholas SR, Lipschutz RD, Gard SA. The biomechanical response of persons with transfemoral amputation to variations in prosthetic knee alignment during level walking. J Rehabil Res Dev. 2016;53(6): 1089–1106.
http://dx.doi.org/10.1682/JRRD.2014.12.0311
ORCID: Sara R. Koehler-McNicholas, PhD: 000-0002-7201-3607; Steven A. Gard, PhD: 0000-0002-4251-2464
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