title: Longitudinal kinematic and kinetic adaptations to obstacle crossing in recent lower limb amputees.
abstract: BACKGROUND
  Obstacle crossing is an important activity of daily living, necessary to avoid tripping or falling, although it is not fully understood how transtibial amputees adapt to performing this activity of daily living following discharge from rehabilitation.
  
  
  OBJECTIVE
  The objective of this study was to investigate the longitudinal adaptations in obstacle crossing in transtibial amputees post-discharge from rehabilitation.
  
  
  METHODS
  Longitudinal repeated measures.
  
  
  METHODS
  Seven unilateral transtibial amputees crossed an obstacle 0.1m high positioned along a walkway while kinematic and kinetic data were recorded at 1, 3 and 6 months post-discharge.
  
  
  RESULTS
  At 6 months post-discharge, walking velocity had increased (0.17 m.s(-1)) with most participants self-selecting an intact lead limb preference. During swing phase, peak knee flexion (p = 0.03) and peak knee power absorption (K4; p = 0.01) were greater with an intact versus affected lead limb preference. Having crossed the obstacle, intact limb peak ankle power generation in pre-swing (A2; p = 0.01) and knee power absorption (K3; p = 0.05) during stance phase were greater when compared to the affected limb.
  
  
  CONCLUSIONS
  Obstacle crossing improved, although a greater reliance on intact limb function was highlighted. Results suggested that further improvements to locomotor performance may be obtained by increasing affected limb knee range of motion and concentric and eccentric strength of the knee extensors and flexors.
  
  
  CONCLUSIONS
  The novel objective data from this study establish an understanding of how recent transtibial amputees adapt to performing obstacle crossing following discharge from rehabilitation. This allows for evidence-based clinical interventions to be developed, aimed at optimising biomechanical function, thus improving overall locomotor performance and perhaps subsequent quality of life.
authors.affiliation: SHAPE Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, UK cleveland.barnett@ntu.ac.uk.
authors.forename: Cleveland T
authors.initials: CT
authors.lastname: Barnett
authors.affiliation: Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia.
authors.forename: Remco C J
authors.initials: RC
authors.lastname: Polman
authors.affiliation: Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia Department of Sport, Health and Exercise Science, University of Hull, Hull, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Vanicek
mesh_terms: D000203:Activities of Daily Living; D000222:Adaptation, Physiological / Q000502:physiology*; D000328:Adult; D000368:Aged; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D001696:Biomechanical Phenomena / Q000502:physiology; D006801:Humans; D007700:Kinetics; D007719:Knee Joint / Q000502:physiology; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010351:Patient Discharge; D016059:Range of Motion, Articular / Q000502:physiology; D013977:Tibia / Q000601:surgery; D013997:Time Factors; D016138:Walking / Q000502:physiology*
keywords: Obstacle crossing; adaptation; amputee; rehabilitation; transtibial