Mediolateral angular momentum changes in persons with amputation during perturbed walking.

Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (p<0.001) during platform oscillations. There were no significant differences between groups in whole body angular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (p<0.05). For the whole body and intact leg, angular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.

Margins of stability in young adults with traumatic transtibial amputation walking in destabilizing environments.

Understanding how lower-limb amputation affects walking stability, specifically in destabilizing environments, is essential for developing effective interventions to prevent falls. This study quantified mediolateral margins of stability (MOS) and MOS sub-components in young individuals with traumatic unilateral transtibial amputation (TTA) and young able-bodied individuals (AB). Thirteen AB and nine TTA completed five 3-min walking trials in a Computer Assisted Rehabilitation ENvironment (CAREN) system under each of three test conditions: no perturbations, pseudo-random mediolateral translations of the platform, and pseudo-random mediolateral translations of the visual field. Compared to the unperturbed trials, TTA exhibited increased mean MOS and MOS variability during platform and visual field perturbations (p<0.010). AB exhibited increased mean MOS during visual field perturbations and increased MOS variability during both platform and visual field perturbations (p<0.050). During platform perturbations, TTA exhibited significantly greater values than AB for mean MOS (p<0.050) and MOS variability (p<0.050); variability of the lateral distance between the center of mass (COM) and base of support at initial contact (p<0.005); mean and variability of the range of COM motion (p<0.010); and variability of COM peak velocity (p<0.050). As determined by mean MOS and MOS variability, young and otherwise healthy individuals with transtibial amputation achieved lateral stability similar to that of their able-bodied counterparts during unperturbed and visually-perturbed walking. However, based on mean and variability of MOS, unilateral transtibial amputation was shown to have affected lateral walking stability during platform perturbations.