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Research
Andrej Olenšek
University Rehabilitation Institute, Republic of Slovenia
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6649-0845
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Due to disrupted motor and proprioceptive function lower limb amputation imposes considerable challenges associated with balance and greatly increases risk of falling in case of perturbations during walking. The aim of this study was to investigate dynamic balancing responses in unilateral transtibial amputees when they were subjected to perturbing pushes to the pelvis in outward direction at the time of foot strike on non-amputated and amputated side during slow walking.
Methods
Fourteen subjects with unilateral transtibial amputation and nine control subjects participated in the study. They were subjected to perturbations that were delivered to the pelvis at the time of foot strike of either the left or right leg. We recorded trajectories of center of pressure and center of mass, durations of in-stance and stepping periods as well as ground reaction forces. Statistical analysis was performed to determine significant differences in dynamic balancing responses between control subjects and subjects with amputation when subjected to outward-directed perturbation upon entering stance phases with non-amputated or amputated side.
Results
When outward-directed perturbations were delivered at the time of foot strike of the non-amputated leg, subjects with amputation were able to modulate center of pressure and ground reaction force similarly as control subjects which indicates application of in-stance balancing strategies. On the other hand, there was a complete lack of in-stance response when perturbations were delivered when the amputated leg entered the stance phase. Subjects with amputations instead used the stepping strategy and adjusted placement of the non-amputated leg in the ensuing stance phase to make a cross-step. Such response resulted in significantly higher displacement of center of mass.
Conclusions
Results of this study suggest that due to the absence of the COP modulation mechanism, which is normally supplied by ankle motor function, people with unilateral transtibial amputation are compelled to choose the stepping strategy over in-stance strategy when they are subjected to outward-directed perturbation on the amputated side. However, the stepping response is less efficient than in-stance response. To improve their balancing responses to unexpected balance perturbation people fitted with passive transtibial prostheses should undergo perturbation-based balance training during clinical rehabilitation.
Keywords
Unilateral transtibial amputation, Dynamic balancing response, Perturbed walking, In-stance strategy, Stepping strategy, Center of mass, Center of pressure, Ground reaction force
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CURRENT STATUS: Published
View the published article at Journal of NeuroEngineering and Rehabilitation.
Version 1
Posted 26 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 17 Apr, 2021
Review #3 received
Received 05 Apr, 2021
Review #1 received
Received 29 Mar, 2021
Review #2 received
Received 27 Mar, 2021
Reviewer #3 agreed
On 21 Mar, 2021
Reviewer #2 agreed
On 10 Mar, 2021
Reviewer #1 agreed
On 07 Mar, 2021
Reviewers invited
Invitations sent on 06 Mar, 2021
First submitted
On 14 Feb, 2021
Editor assigned
On 14 Feb, 2021
Submission checks complete
On 14 Feb, 2021
Editor invited
On 14 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Physical Medicine & Rehab
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Journal of NeuroEngineering and Rehabilitation.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Andrej Olenšek
University Rehabilitation Institute, Republic of Slovenia
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6649-0845
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of NeuroEngineering and Rehabilitation.
Version 1
Posted 26 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 17 Apr, 2021
Review #3 received
Received 05 Apr, 2021
Review #1 received
Received 29 Mar, 2021
Review #2 received
Received 27 Mar, 2021
Reviewer #3 agreed
On 21 Mar, 2021
Reviewer #2 agreed
On 10 Mar, 2021
Reviewer #1 agreed
On 07 Mar, 2021
Reviewers invited
Invitations sent on 06 Mar, 2021
First submitted
On 14 Feb, 2021
Editor assigned
On 14 Feb, 2021
Submission checks complete
On 14 Feb, 2021
Editor invited
On 14 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Physical Medicine & Rehab
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of NeuroEngineering and Rehabilitation.
Background
Due to disrupted motor and proprioceptive function lower limb amputation imposes considerable challenges associated with balance and greatly increases risk of falling in case of perturbations during walking. The aim of this study was to investigate dynamic balancing responses in unilateral transtibial amputees when they were subjected to perturbing pushes to the pelvis in outward direction at the time of foot strike on non-amputated and amputated side during slow walking.
Methods
Fourteen subjects with unilateral transtibial amputation and nine control subjects participated in the study. They were subjected to perturbations that were delivered to the pelvis at the time of foot strike of either the left or right leg. We recorded trajectories of center of pressure and center of mass, durations of in-stance and stepping periods as well as ground reaction forces. Statistical analysis was performed to determine significant differences in dynamic balancing responses between control subjects and subjects with amputation when subjected to outward-directed perturbation upon entering stance phases with non-amputated or amputated side.
Results
When outward-directed perturbations were delivered at the time of foot strike of the non-amputated leg, subjects with amputation were able to modulate center of pressure and ground reaction force similarly as control subjects which indicates application of in-stance balancing strategies. On the other hand, there was a complete lack of in-stance response when perturbations were delivered when the amputated leg entered the stance phase. Subjects with amputations instead used the stepping strategy and adjusted placement of the non-amputated leg in the ensuing stance phase to make a cross-step. Such response resulted in significantly higher displacement of center of mass.
Conclusions
Results of this study suggest that due to the absence of the COP modulation mechanism, which is normally supplied by ankle motor function, people with unilateral transtibial amputation are compelled to choose the stepping strategy over in-stance strategy when they are subjected to outward-directed perturbation on the amputated side. However, the stepping response is less efficient than in-stance response. To improve their balancing responses to unexpected balance perturbation people fitted with passive transtibial prostheses should undergo perturbation-based balance training during clinical rehabilitation.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
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