title: Uphill and downhill walking in unilateral lower limb amputees.
abstract: OBJECTIVE
  To study adjustment strategies in unilateral amputees in uphill and downhill walking.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects.
  
  
  METHODS
  In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured.
  
  
  RESULTS
  In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body.
  
  
  CONCLUSIONS
  Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.
authors.affiliation: Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.h.vrieling@rev.umcg.nl
authors.forename: A H
authors.initials: AH
authors.lastname: Vrieling
authors.forename: H G
authors.initials: HG
authors.lastname: van Keeken
authors.forename: T
authors.initials: T
authors.lastname: Schoppen
authors.forename: E
authors.initials: E
authors.lastname: Otten
authors.forename: J P K
authors.initials: JP
authors.lastname: Halbertsma
authors.forename: A L
authors.initials: AL
authors.lastname: Hof
authors.forename: K
authors.initials: K
authors.lastname: Postema
mesh_terms: D000328:Adult; D000368:Aged; D000674:Amputees / Q000534:rehabilitation; D001186:Artificial Limbs; D015331:Cohort Studies; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D007866:Leg; D008297:Male; D008875:Middle Aged; D016138:Walking / Q000502:physiology*