Dual-task walking over a compliant foam surface: A comparison of people with transfemoral amputation and controls

People with lower limb amputation are unable to reliably sense ground characteristics due to compromised sensory inputs from the missing limb. As a result, they may rely on compensatory strategies, such as use of cognitive resources, when walking over complex surfaces. This study examined interactions between cognition and walking over a compliant surface in 14 people with transfemoral amputation (TFA) and 14 controls using a dual-task paradigm. Walking was assessed with quantitative motion analysis in both single-task (walking alone) and dual-task (walking while performing a cognitive task) conditions over a compliant foam surface. Outcomes were walking speed, step width, step time asymmetry, step time variability, and the speed and accuracy of cognitive task performance. For each outcome, effects of task (single-task, dual-task) and group (TFA, control) were examined with repeated-measures analysis of variance. No significant group-by-task interactions were observed for cognitive task performance. A significant group-by-task interaction for step time asymmetry indicated that participants with TFA increased temporal asymmetry in dual-task relative to single-task conditions, while control participants maintained symmetrical gait. The addition of a concurrent cognitive task did not differentially affect other aspects of gait between groups. Significant main effects of group for all walking outcomes indicated that participants with TFA walked slower, with wider, more asymmetric, and more variable steps than controls. Results suggest that gait quality degrades in challenging dual-task conditions for people with TFA, but not controls, consistent with the idea that people with TFA may use increased cognitive resources to control walking in complex environments.