Effects of Handrail and Cane Support on Energy Cost of Walking in People With Different Levels and Causes of Lower Limb Amputation

Han Houdijk*, Ilse J. Blokland, Suci A. Nazier, Saskia V. Castenmiller, Iris van den Heuvel, Trienke IJmker

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Objective: The energy cost of walking with a lower limb prosthesis is higher than 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 extent 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 nonvascular causes, 16 at transtibial, and 10 at transfemoral or knee disarticulation level (N=26). Interventions: Participants walked on a treadmill with and without handrail support and overground with and without a cane. Main Outcome Measures: Energy cost was assessed using respirometry. Results: On the treadmill, handrail support resulted in a 6% reduction in energy cost on average. This effect was attributed to an 11% reduction in those with an amputation attributable to vascular causes, whereas the nonvascular 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 nonsignificant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the nonvascular 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 due to vascular causes with reduced walking ability while walking in the more challenging condition of the treadmill. Although it is speculated that this effect might be related to problems with balance control, this will need further investigation.

Original languageEnglish
Pages (from-to)1340-1346.e3
JournalArchives of Physical Medicine and Rehabilitation
Issue number7
Publication statusPublished - Jul 2021

Bibliographical note

Publisher Copyright:
© 2021 The American Congress of Rehabilitation Medicine

Copyright 2021 Elsevier B.V., All rights reserved.


  • Amputation
  • Artificial limbs
  • Gait
  • Lower extremity
  • Oxygen consumption
  • Rehabilitation


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