Aided prosthetic gait of people with lower-limb amputations: Comparison of four-footed and two-wheeled walkers

The objective of this project was to compare the performance and stability of the four-footed walker (FFW) and two-wheeled walker (TWW) as used by patients with lower-limb amputations, testing the hypotheses that firstly, the TWW has a better performance compared to the FFW (specifically, a higher walking speed and less interruption between each step, secondly, the TWW is no less safe than the FFW (specifically, the need for spotter intervention) and finally, the TWW is preferred by people with lower-limb amputations.;The project was carried out in a hospital locomotor function laboratory setting and was designed to facilitate within-subject comparisons. Twenty volunteers with lower-limb amputations excluding those with Syme's amputations were recruited. Participants were trained to use both the FFW and the TWW to ambulate 5m and return at their self-selected paces. The main outcome measures were 5m walking velocity, spotter intervention, ankle positions with respect to the base of support of the walker and subjects' preference. Other secondary measures included heart rate and prosthetic gait patterns.;Participants showed 28.5% higher walking velocities when using the TWW (p = 0.000). There was no statistically significant evidence of difference in safety from the perspective of spotter intervention. Unilateral amputee patients placed their ankles significantly more anteriorly within the walker base of support when using a FFW (p = 0.000). Six different step-stride patterns were documented. The double support phase was 10% longer when subjects were ambulating with the FFW then with the TWW (p = 0.001). Fourteen participants preferred the TWW and six chose the FFW. The result on subjects' walker preference was not statistically significant.;The TWW allows people with lower-limb amputations to walk more quickly, with less interruption and no less safety than the FFW. Patients should be trained with both walkers and be permitted to choose the one that best meets their needs.