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KNEE MOMENT SYMMETRY DURING HILL WALKING 153

crossing, ramps, stairs, speed variation, and variable ramp downhill, 5) fast speed (i.e., hurried, late for
surfaces. Portions of the training techniques used in appointment) on 5° ramp uphill, and 6) fast speed on
this protocol have been previously published (1,7). 5° ramp downhill. Subjects were given the opportu-
The minimum accommodation period was two nity to rest between tests. A total of six different trial
weeks. After this, subjects were contacted weekly types were assessed, and each type was completed
to determine their ability to walk without personal twice to record data over the force platform for both
assistance on 1) level ground, 2) inclines, 3) declines, the prosthetic and anatomical leg.
4) up & down stairs, and 5) on uneven ground. Sub-
jects could contact investigators at any time after Data Processing
the two-week minimum to declare their readiness Tracking segments were defined using the sur-
to physically demonstrate they had accommodated face markers, and redundancy was included in the
to their currently assigned knee and study foot. Sub- marker set to compensate for marker drop out and
jects were considered accommodated after verbally to increase data consistency and reliability. Frames
acknowledging and physically demonstrating their were tracked by least squares minimization of the
ability to ambulate independently on all five of the in-segment marker reconstruction error (12). A
previous terrains. This study accommodation test was combination of anatomical markers and calculated
adapted from Hafner et al. (8,9). Following accom- joint centers were then used to define anatomical
modation, subjects were scheduled for initial testing.
Following initial testing, knee units were switched, segments. Segment axes definitions were based on
and the process was repeated for follow-up testing. the recommendations of the International Society of
Biomechanics (13). Joint angles were calculated from
Testing Euler angle transformations of anatomical segments.
Although the marker set used enabled tracking of
Passive marker-based 3D motion tracking was the entire lower body, knee flexion moment was the
selected to record and analyze knee movements measure of interest that addressed the a priori hypoth-
because it is valid, reliable, and considered to be the eses, and therefore was the only measure included
gold standard measurement technique for gait anal- in this report. The gait cycle was defined from heel
ysis (10). Specifically, an 8-camera Vicon motion
analysis system was used to collect knee kinematic strike to heel strike of the involved foot. Peak knee
flexion moment was defined as the maximum knee
data of subjects performing hill gait tasks. Passive
reflective markers were attached to subjects using flexion moment from 0% to 30% of the gait cycle to
neoprene straps and double side adhesive collars as assure peak stance flexion in the loading response.
previously described (6). Force platforms (AMTI, The remainder of the gait cycle (30% to 100%) was
Watertown, MA, USA) were embedded in the gait considered swing phase and was not included in
platform and ramps and used to record ground reac- this report. These definitions were used to prevent
tion forces and to time events. For instance, heel strike subjects who used the ‘ride-down’ strategy on the
and toe off were identified with force plate data; how- ramp descent from inflating the stance flexion angles
ever, the subsequent heel strike was recorded with after the loading response and further increasing
kinematic approximation (11). In accordance with deviations in subject moment data. Vertical ground
manufacturer specifications and recommendations, reaction forces (GRF) were determined from the
the Vicon cameras were calibrated and force platforms force plates. A 2D kinematic model was written in
zeroed before each session and after adjusting the Vicon Bodybuilder software to determine joint angles,
ramp to the slope condition. forces, and moments of the knee in the sagittal plane.
All subjects completed the hill walking tasks in DoA between sound and prosthetic side knee flex-
the same order: 1) normal speed on 5° ramp uphill, ion moments of the same trial type was calculated
2) normal speed on 5° ramp downhill, 3) slow speed using the following equation:
(i.e., casual) on 5° ramp uphill, 4) slow speed on 5°