The Effect of a Weighted Pack on the Gait Patterns of Transtibial Amputees

With the popularity of outdoor activities like hiking, the demands of certain types of employment, or being a student, an individual’s ability to carry a load is an important mobility consideration. By understanding the changes to an individual’s gait when supporting a backpack load, an individual’s ability to carry heavy loads for prolonged periods could be improved. Most biomechanical studies have examined the changes in able-bodied gait when carrying a load. However, research is lacking on the effect of backpack loads on amputee gait patterns. This project examined the effects of a backpack load on the gait patterns of unilateral transtibial amputees. Ten participants performed walking trials on four surfaces (level ground, uneven ground, walking up an incline, and walking down an incline), without a pack and with a pack. A total of 40 trials were collected per subject, with 10 trials collected on each surface. Three-dimensional motion data were collected with an eight-camera Vicon Motion Analysis system to describe limb motion as well as compare kinematic outcomes between tasks and conditions. Force platform data were collected during the level ground trials and used to calculate kinetic measures for both limbs. With the addition of the pack changes were seen on each surface, with different changes occurring to each limb. The ramp up surface created the most changes when comparing the two conditions. The only change seen across all four surfaces was a decrease in ankle dorsiflexion before push-off on the prosthetic limb. The two next most common changes were increases in knee and hip flexion during weightacceptance.

[1]  Y L Chou,et al.  Gait analysis and energy consumption of below-knee amputees wearing three different prosthetic feet. , 2000, Gait & posture.

[2]  A. McIntosh,et al.  Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis. , 2008, Gait & posture.

[3]  G Vanneuville,et al.  The effect of loads carried on the shoulders. , 1999, Military medicine.

[4]  Lei Ren,et al.  Dynamic analysis of load carriage biomechanics during level walking. , 2005, Journal of biomechanics.

[5]  P. Korovessis,et al.  Backpacks, Back Pain, Sagittal Spinal Curves and Trunk Alignment in Adolescents: A Logistic and Multinomial Logistic Analysis , 2005, Spine.

[6]  R. Cromwell,et al.  Adaptive changes in gait of older and younger adults as responses to challenges to dynamic balance. , 2008, Journal of aging and physical activity.

[7]  R. Brand,et al.  The biomechanics and motor control of human gait: Normal, elderly, and pathological , 1992 .

[8]  Y. Bhambhani,et al.  Physiological and biomechanical responses during treadmill walking with graded loads , 1997, European Journal of Applied Physiology and Occupational Physiology.

[9]  Sandra J. Olney,et al.  Kinematic and Kinetic Variations of Below-Knee Amputee Gait , 2002 .

[10]  H. Kinoshita,et al.  Effects of different loads and carrying systems on selected biomechanical parameters describing walking gait. , 1985, Ergonomics.

[11]  G D Reiber,et al.  Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. , 1998, Archives of physical medicine and rehabilitation.

[12]  E. Isakov,et al.  Transtibial amputee gait: Timedistance parameters and EMG activity , 2000, Prosthetics and orthotics international.

[13]  Gary A Mirka,et al.  The effects of a suspended-load backpack on gait. , 2009, Gait & posture.

[14]  A. Patla,et al.  Age-related changes in gait for multi-surface terrain. , 2008, Gait & posture.

[15]  Phillip D Tomporowski,et al.  Effects of backpack load on balance and decisional processes. , 2009, Military medicine.

[16]  E. Ayyappa Normal Human Locomotion, Part 1: Basic Concepts and Terminology , 1997 .

[17]  Arthur D Kuo,et al.  The six determinants of gait and the inverted pendulum analogy: A dynamic walking perspective. , 2007, Human movement science.

[18]  Philip E. Martin,et al.  Lower extremity kinematic and kinetic adaptations in unilateral below-knee amputees during walking , 1997 .

[19]  J. Ashton-Miller,et al.  Effects of surface irregularity and lighting on step variability during gait: a study in healthy young and older women. , 2005, Gait & posture.

[20]  Richard A. Brand,et al.  The biomechanics and motor control of human gait: Normal, elderly, and pathological , 1992 .

[21]  Jasmine C Menant,et al.  Effects of walking surfaces and footwear on temporo-spatial gait parameters in young and older people. , 2009, Gait & posture.

[22]  D. Winter,et al.  Biomechanical walking pattern changes in the fit and healthy elderly. , 1990, Physical therapy.

[23]  C. Ekdahl,et al.  Gait in male trans-tibial amputees: A comparative study with healthy subjects in relation to walking speed , 1994, Prosthetics and orthotics international.

[24]  R. Hooper,et al.  The kinetic and kinematic effects of increasing load carriage upon the lower limb , 1999 .

[25]  K. Holt,et al.  How do load carriage and walking speed influence trunk coordination and stride parameters? , 2003, Journal of biomechanics.

[26]  M. Patel,et al.  The effect of foam surface properties on postural stability assessment while standing. , 2008, Gait & posture.

[27]  M. Moore,et al.  Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents. , 2007, The Journal of school health.

[28]  Stewart A Birrell,et al.  The effect of load distribution within military load carriage systems on the kinetics of human gait. , 2010, Applied ergonomics.

[29]  H. Barbeau,et al.  Postural adaptation to walking on inclined surfaces: I. Normal strategies. , 2002, Gait & posture.

[30]  J. Paysant,et al.  Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees. , 2006, Journal of rehabilitation research and development.

[31]  A. Lees,et al.  The functional demands on the intact limb during walking for active transfemoral and transtibial amputees , 2000, Prosthetics and orthotics international.

[32]  Ji-Woon Park,et al.  Three-Dimensional Kinematic Analysis during Upslope Walking with Different Inclinations by Healthy Adults , 2009 .

[33]  S. Simon,et al.  Biomechanical and metabolic effects of varying backpack loading on simulated marching , 2000, Ergonomics.

[34]  J Charteris,et al.  Comparison of the effects of backpack loading and of walking speed on foot-floor contact patterns. , 1998, Ergonomics.

[35]  Vladimir Medved,et al.  Spatial, temporal and kinematic characteristics of traumatic transtibial amputees' gait. , 2010, Collegium antropologicum.

[36]  A. Patla,et al.  Adapting locomotion to different surface compliances: neuromuscular responses and changes in movement dynamics. , 2005, Journal of neurophysiology.

[37]  J Paysant,et al.  Compensatory mechanism involving the hip joint of the intact limb during gait in unilateral trans-tibial amputees. , 2008, Journal of biomechanics.

[38]  M. Redfern,et al.  Biomechanics of descending ramps , 1997 .

[39]  Thomas D. Collins,et al.  A six degrees-of-freedom marker set for gait analysis: repeatability and comparison with a modified Helen Hayes set. , 2009, Gait & posture.

[40]  Andrea N. Lay,et al.  The effects of sloped surfaces on locomotion: a kinematic and kinetic analysis. , 2006, Journal of biomechanics.

[41]  G. M. Ghori,et al.  Responses of the lower limb to load carrying in walking man , 2006, European Journal of Applied Physiology and Occupational Physiology.

[42]  C. Diss The reliability of kinetic and kinematic variables used to analyse normal running gait. , 2001, Gait & posture.

[43]  R. C. Nelson,et al.  The effect of carried loads on the walking patterns of men and women. , 1986, Ergonomics.

[44]  Perry,et al.  Knee kinetics in trans-tibial amputee gait. , 1998, Gait & posture.

[45]  S. Birrell,et al.  The effect of military load carriage on ground reaction forces. , 2007, Gait & posture.

[46]  M F Haisman,et al.  Determinants of load carrying ability. , 1988, Applied ergonomics.

[47]  H B Skinner,et al.  The relationship between gait parameters and pain in persons with transtibial amputation: a preliminary report. , 1998, Journal of rehabilitation research and development.

[48]  J. Frank,et al.  Locomotor adaptations for changes in the slope of the walking surface. , 2004, Gait & posture.

[49]  A L Hof,et al.  Uphill and downhill walking in unilateral lower limb amputees. , 2008, Gait & posture.

[50]  R W Norman,et al.  Metabolic measures to ascertain the optimal load to be carried by man. , 1981, Ergonomics.

[51]  R. Olshen,et al.  The development of mature gait. , 1980, The Journal of bone and joint surgery. American volume.

[52]  T. Oberg,et al.  Basic gait parameters: reference data for normal subjects, 10-79 years of age. , 1993, Journal of rehabilitation research and development.

[53]  A. McIntosh,et al.  Gait dynamics on an inclined walkway. , 2006, Journal of biomechanics.

[54]  A. Hof,et al.  Gait initiation in lower limb amputees. , 2008, Gait & posture.

[55]  T. Schmalz,et al.  Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. , 2002, Gait & posture.

[56]  D. Sutherland,et al.  A practical guide to gait analysis. , 2002, The Journal of the American Academy of Orthopaedic Surgeons.

[57]  W. Miller,et al.  Lower extremity prosthetic mobility: a comparison of 3 self-report scales. , 2001, Archives of physical medicine and rehabilitation.

[58]  The effects of backpack load carrying on dynamic balance as measured by limits of stability. , 2001, Work.

[59]  F Lavaste,et al.  A Functional Evaluation of Prosthetic Foot Kinematics During Lower-Limb Amputee Gait , 2006, Prosthetics and orthotics international.

[60]  R. L. Attwells,et al.  Influence of carrying heavy loads on soldiers' posture, movements and gait , 2006, Ergonomics.

[61]  S. Nadeau,et al.  Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? , 2003, Clinical biomechanics.

[62]  J. Tukey,et al.  Performance of Some Resistant Rules for Outlier Labeling , 1986 .

[63]  D. Winter,et al.  Biomechanics of below-knee amputee gait. , 1988, Journal of biomechanics.

[64]  S. Wolf,et al.  Biomechanical analysis of ramp ambulation of transtibial amputees with an adaptive ankle foot system. , 2010, Gait & posture.

[65]  J. Knapik,et al.  Load carriage using packs: a review of physiological, biomechanical and medical aspects. , 1996, Applied ergonomics.

[66]  C. Charalambous The Major Determinants in Normal and Pathological Gait , 2014 .

[67]  Edmond Ayyappa Normal Human Locomotion, Part 2: Motion, Ground‐Reaction Force and Muscle Activity , 1997 .

[68]  E D Lemaire,et al.  Indicators of dynamic stability in transtibial prosthesis users. , 2010, Gait & posture.

[69]  A D Holmes,et al.  Changes in spinal curvature and proprioception of schoolboys carrying different weights of backpack , 2007, Ergonomics.