Kinematic patterns of participants with a below-knee prosthesis stepping over obstacles of various heights during locomotion

The focus of this paper was to examine the lead limb preference and the kinematic patterns of the lead limb of participants with a unilateral below-knee prosthesis when stepping over obstacles of different heights. Firstly, ten unilateral below-knee amputees stepped over obstacles of three different heights placed in their walking path to determine if they had a lead limb preference. Five of the ten participants demonstrated a sound limb lead preference, two participants showed a prosthetic limb lead preference and three showed no preference at all. Seven of these participants subsequently stepped over obstacles of six different heights leading with their sound or prosthetic limb as observed in the first experiment, while whole body kinematic data were collected. Relative joint angles of the stance and swing limb were calculated when the swing limb was over the obstacle. Swing hip elevation and hip and knee flexion increased as functions of obstacle height. Stance limb hip flexion, knee flexion and (on the sound side) ankle plantarflexion increased slightly with increasing obstacle height, but stance limb hip elevation did not. Therefore, it appears that these stance limb modulations served to position the pelvis further back from the obstacle as obstacle height increased. The posterior shell of the prosthetic socket limited residual limb swing knee flexion, and the increased ankle dorsiflexion seen on the lead sound side was not present on the lead prosthetic side. These limitations were associated with increased swing prosthetic foot angle and increased stance ankle plantarflexion. These results provide insights into the adaptability of the locomotor system, and have implications for lower extremity prosthetic design and amputee rehabilitation.