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Lower Limb AmputationNCT07831707

The Role of Visual Attention and Environmental Complexity in Real-world Mobility for People With Lower Limb Amputation

An observational study of Lower Limb Amputation, run by Virginia Commonwealth University at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Despite high medical expenses (>$500K/patient), mobility improvements achieved during rehabilitation for people with lower limb amputation (LLA) fail to translate into improved real-world outcomes. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lower Limb Amputation
What is being tested?
Comprehensive assessment of walking patterns and functional mobility, Comprehensive assessment of eye movements during walking and Questionnaire Assessments completed
How many people
30 participants
Where
1 siteUnited States
Study dates
25 Oct 2025to 31 May 2027
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: We will compare gait speed (Aim1) and gaze behavior with eye-tracking glasses (Aim 2) during vision-based (visual puzzles) and non-vision-based (serial subtraction) cognitive-motor dual-tasking while walking on low and high complexity terrain in people with LLA (n=20) and matched controls (n=10).

Who may be able to join

  • unilateral transtibial LLA of either dysvascular (diabetes, peripheral vascular disease, and/or infection) or traumatic etiology
  • 18 years old minimum
  • able to ambulate 2 minutes without rest
  • 9 months since LLA
  • fitted with terminal prosthesis
  • 20/60 vision or better (with or without glasses/contacts)

Who cannot join

  • congenital or cancer-related LLA
  • ankle-level or above LLA on the contralateral limb
  • residual limb wound or contralateral foot ulcer
  • unstable heart condition (including unstable angina, uncontrolled cardiac dysrhythmia, acute myocarditis, hypertension, and acute pericarditis)
  • acute systemic infection
  • prisoner
Show all 15Show fewer
  • inability to follow a 3-step command
  • concussion/brain injury in the past 12 months
  • active cancer treatment
  • preexisting neurological condition (i.e., multiple sclerosis, Parkinson's disease)
  • participating in prosthetic rehabilitation
  • color-blindness
  • history of seizure(s)
  • inability to read and communicate in English.
  • Participants in the control group must meet the non-amputation-related criteria noted above, be within ±2 years and the same biological sex as their paired participants with LLA.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Paul Kline contact

804-828-4483

klinep@vcu.edu

United States1 site, 1 recruiting
  • Virginia Commonwealth University

    Richmond, Virginia, 23239

    Paul Kline, 804-828-4483, klinep@vcu.edu

    Paul Kline

    Recruiting

Other trials in United States

About this study

Despite high medical expenses (>$500K/patient), mobility improvements achieved during rehabilitation for people with lower limb amputation (LLA) fail to translate into improved real-world outcomes. Even with advances in prosthesis technology enabling faster gait speed, greater walking endurance, and improved mobility confidence, people with LLA report persistent dissatisfaction with real-world mobility, limited ability to walk in the community, and difficulty achieving recommended physical activity levels.

Real-world walking requires thinking and moving simultaneously (e.g., cognitive-motor dual-tasking), visually attending to the environment, and navigating varying terrain. In contrast, clinical mobility assessments are usually performed without additional visual or cognitive demands, in controlled environments, and on level surfaces. Current clinical tools used to assess ambulation progression during rehabilitation do not adequately assess these changes in people who have experienced LLA.

Read the detailed description

A step toward rectifying a critical gap in care for those with LLA by quantifying the effect of vision-based and non-vision-based cognitive-motor dual-tasking and high and low complexity terrain on gait speed and gaze behavior. Cognitive-motor dual-task assessment paradigms are well-established in other populations and often used to better approximate real-world walking demands. However, the type of cognitive task used is an important factor. The most common methods for dual-task assessment in people with LLA are limited to cognitive tasks lacking overt visual attention (e.g., serial subtraction - performing repeated subtractions from a given starting number).Although walking while performing non-vision-based cognitive tasks results in slower gait speed than single-task walking, this type of task has limited ecological validity and the observed dual-task performances have not been associated with real-world walking outcomes.

Performing vision-based cognitive-motor dual-tasks is particularly important for people with LLA. Due to lost somatosensory input from the amputated limb, the central nervous system increases dependence on visual input for sensorimotor integration. As a result, people with LLA report needing to "concentrate on every step", and affix their gaze on each subsequent step compared to 3 steps ahead like adults without LLA.

Current clinical assessments fail to detect impairments during mobility tasks requiring visual attention in complex environments. The lack of understanding of the interaction between visual attention and complex environment precludes a comprehensive mobility assessment, allows undetected impairments to persist, and limits translation of rehabilitation gains into improved real-world mobility outcomes.

Being tested
Comprehensive assessment of walking patterns and functional mobility, Comprehensive assessment of eye movements during walking, Questionnaire Assessments completed

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Comprehensive assessment of walking patterns and functional mobilityOther

    Assessment of accelerometry: Daily duration (minutes) of sitting, standing, stepping, Daily step count, Daily walking bouts stepping cadence, Timed Up and Go and Two-minute Walk Test

  • Comprehensive assessment of eye movements during walkingOther

    Comprehensive assessment of eye movements during walking including Target Fixation Time (seconds; %) and Number of fixations

  • Questionnaire Assessments completedOther

    The following assessments will be completed: World health organization disability assessment schedule 2.0 (WHODAS), and Activities Specific Balance Confidence Scale.

Study groups in NCT07831707
Study groupRoleWhat they receive
Subjects with Lower Limb Amputation (LLA)20 participants with below knee amputation.
Receives: Other: Comprehensive assessment of walking patterns and functional mobility; Other: Comprehensive assessment of eye movements during walking; Other: Questionnaire Assessments completed
Matched Control10 sex- and age-matched control participants.
Receives: Other: Comprehensive assessment of walking patterns and functional mobility; Other: Comprehensive assessment of eye movements during walking; Other: Questionnaire Assessments completed

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Gait Analysis-Walking Speed

    Measure walking speed meters/second. Captured during dual-task and single-task walking, it is used to measure motor performance. Normal Speed: Healthy adults usually walk at 1.2 to 1.4 meters per second.Fall Risk: A speed below 1.0 meter per second shows a higher risk for falls.Frailty Warning: A speed below 0.6 to 0.8 meters per second suggests a high risk of functional decline or disability.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  2. Gait Analysis-Stride Length

    Measure the stride length in meters. stride length is the total distance covered during one full cycle of walking or running with the same foot. It measures the space from where one foot touches the ground to when that exact same foot touches the ground again.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  3. Gait Analysis-Stride length asymmetry

    Assess Stride length asymmetry is an imbalance where the distance covered by the right and left steps differs. Symmetry Index (SI): Compares spatial step metrics or temporal single-limb support times between limbs.Percentage difference: Calculated by contrasting mean left and right step values; values exceeding 10% typically indicate notable dysfunction.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  4. Cognitive Task Performance Cognitive Task Performance

    Accuracy (percentage correct) of each cognitive task. This reflects cognitive performance and is measured in both dual-task and single-task conditions.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  5. Cognitive Task Performance

    Measure Response time (milliseconds)

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  6. Functional Mobility (Two-minute Walk Test)

    Two-minute Walk Test measures the total distance a person can walk on a flat, hard surface within two minutes. It evaluates functional mobility, submaximal endurance, and self-paced walking capacity in adults. Recorded to the nearest meter or foot using a measuring wheel, and lap count.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  7. Functional Mobility (Timed Up and Go)

    Timed Up and Go (TUG) test measures functional mobility, dynamic balance, and fall risk by timing how fast a person stands from a chair, walks 3 meters (10 feet), turns around, walks back, and sits down. Under 10-12 seconds: Normal, independent mobility with low fall risk.12-20 seconds: Moderate risk of falling or subtle mobility issues; requires further evaluation.Over 14-20 seconds: High risk for falls; often indicates difficulty moving outside alone or a need for assistive devices.

    Measured: Visit 1

  8. Eye Tracking (Target Fixation Time)

    Target Fixation Time (seconds; %), The length of time the eye remains relatively still on a target to process detail, reflecting visual attention.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  9. Eye Tracking (Number of fixations)

    Number of fixations is a core metric measuring how many times a person's eyes pause and focus on a specific area or object. High Fixation Count: indicates frequent attention on an area or element. Low Fixation Count: Means an element was quickly passed over, easily understood, or ignored.

    Measured: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)

  10. Patient Reported Outcomes (Houghton Scale)

    The Houghton Scale assesses a person's confidence and ability in using their prosthesis safely and effectively during everyday mobility tasks. The Houghton Scale is a self-administered, 4-item questionnaire used to assess the functional use of a prosthesis by individuals with lower-limb amputations.It measures how often a patient wears their prosthesis, the types of activities they perform with it, and their perceived stability in various outdoor environments. Total scores range from 0 to 12, with higher scores indicating greater prosthesis use and independence

    Measured: Visit 1

  11. Patient Reported Outcomes (PEQ - Mobility subscale)

    PEQ - Mobility subscale is the The Prosthesis Evaluation Questionnaire - Mobility subscale, captures a person's self reported ability to move and perform daily activities while using their prosthesis. It uses a 5-point ordinal scale (0-4). 0: Not able or hardly able to 4: No problem or almost fully able. The total scale ranges from 0 to 48. A higher score indicates greater mobility.

    Measured: Visit 1

  12. Patient Reported Outcomes (WHODAS)

    WHODAS The World health organization disability assessment schedule 2.0 (WHODAS) evaluates how health conditions impact a person's functioning and participation across major life domains over the past 30 days. Items are rated on a 5-point Likert scale: None (0), Mild (1), Moderate (2), Severe (3), and Extreme or Cannot Do (4). While no universal "cut-off" exists, scores placing a patient in the top 10% of the population distribution-roughly >10 for the 12-item simple score or >41 for the 36-item version-likely indicate significant impairment.

    Measured: Visit 1

  13. Patient Reported Outcomes (Activities Specific Balance Confidence Scale)

    Activities Specific Balance Confidence Scale is a self-report instrument used to measure an individual's confidence in maintaining balance while performing 16 various daily activities. Unlike performance-based tests, it captures the patient's perceived ability to avoid falling or becoming unsteady.Patients rate their confidence for each item on a scale from 0% (no confidence) to 100% (complete confidence). The higher the score,the higher the function and physical activity (range > 80% high function, 50% - 80% moderate function and < 50% low function.

    Measured: Visit 1

  14. Accelerometry (Daily duration of sitting, standing, stepping)

    Daily duration (minutes) of sitting, standing, and stepping reported as an aggregate mean.

    Measured: Between Visit 1 and 2 (which is 10-14 days after visit 1)

  15. Accelerometry (Daily step count)

    Daily step count will be measured and reported as an aggregate mean.

    Measured: Between Visit 1 and 2 (which is 10-14 days after visit 1)

  16. Accelerometry (Daily walking bouts stepping cadence)

    Daily walking bouts stepping cadence will be reported as an aggregate mean

    Measured: Between Visit 1 and 2 (which is 10-14 days after visit 1)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Sep 2026
  2. Study start25 Oct 2025
  3. Primary completion31 May 2027 (estimated)
  4. Study completion31 May 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
30 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07831707
Sponsor's protocol ID
HM20030568
Status last verified
Sep 2026
First submitted
14 Sep 2026
Last updated
21 Sep 2026
Results posted
No
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

An observational study of Lower Limb Amputation, run by Virginia Commonwealth University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 21 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Paul Kline (804-828-4483, klinep@vcu.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Gait Analysis-Walking Speed (time frame: Visit 1 and visit 2 (which will take place 10-14 days after visit 1)). The study lists 16 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Sep 2026.

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