LAUSR

OBJECTIVE The energy cost of walking with a lower limb prosthesis is higher compared to able-bodied walking, and depends on both cause and level of amputation. This increase might partly be related to problems with balance control. In this study we investigated to what extend energy cost can be reduced by providing support through a handrail or cane and how this depends on level and cause of amputation. DESIGN Quasi-experimental study. SETTING Rehabilitation gait laboratory. PARTICIPANTS Twenty-six people with a lower limb amputation were included; 9 with vascular and 17 with non-vascular cause, 16 at transtibial and 10 at transfemoral or knee disarticulation level. INTERVENTIONS Participants walked on a treadmill with and without handrail support and overground with and without a cane. MAIN OUTCOME MEASURE(S) Energy cost was assessed using respirometry. RESULTS On the treadmill handrail support resulted on average in a 6% reduction of energy cost. This effect was attributed to an 11% reduction in those with an amputation due to vascular causes, while the non-vascular group did not show a significant difference. No interaction with level of amputation was found. Overground, no main effect of cane support was found, although an interaction effect with cause of amputation demonstrated a small, non-significant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the non-vascular group when walking with a cane. The effect of support was positively correlated with self-selected walking speed. CONCLUSIONS This study demonstrates that providing external support can contribute to a reduction in energy cost in people with an amputation to vascular causes, with reduced walking ability, while walking in the more challenging condition of the treadmill. While it is speculated that this effect might be related to problems with balance control, this will need further investigation.