Increased prefrontal cortical activation during challenging walking conditions in persons with lower limb amputation - an fNIRS observational study.

Background: Lower limb amputation (LLA) alters the sensorimotor control systems. Despite the self-reports of increased attention during mobility, the interaction between mobility and cognitive control mechanisms is not fully understood.Objective: Concurrently evaluate walking performance and prefrontal cortical (PFC) activity in persons with and without LLA during different walking conditions.Methods: Thirty-nine persons with LLA and thirty-three able-bodied controls participated. Walking performance was evaluated using the Figure-of 8-walk-test during three conditions: 1) UW (Usual walking with self-selected walking speed); 2) WCT (walking and carrying a tray with two cups filled with water); and 3) WUT (walking on uneven terrain). PFC activity was assessed using functional near-infrared spectroscopy (fNIRS). Linear mixed models were used to detect changes between groups and between walking conditions within each group.Results: Between-group comparisons showed increased PFC activity in persons with LLA during UW and WUT, and a significant decrease in walking performance during WCT and WUT compared to controls. Within-group comparisons showed increased PFC activity during WUT compared with UW and WCT and an overall difference in walking performance between the conditions (WU > WUT > WCT) in both groups. However, the effect of walking condition on PFC activity and walking performance was not modified by group (P > .1).Conclusion: The results suggest that persons with LLA have increased attentional demands during walking but choose the same cognitive-mobility strategy during challenging walking conditions as able-bodied persons. However, the attentional demands seem to depend on the complexity of the task.

Assessing mobility for persons with lower limb amputation: the Figure-of-Eight Walk Test with the inclusion of two novel conditions.

PURPOSE: To investigate the internal consistency, convergent and known-groups construct validity of the Figure-of-Eight Walk Test with two novel conditions in persons with lower limb amputation, and to examine differences in walking performance between the three conditions within a group of persons with transtibial amputation and transfemoral amputation/knee disarticulation. MATERIALS AND METHODS: Fifty adults with unilateral amputation participated, 28 of whom had undergone a transtibial amputation and 22 a transfemoral amputation/knee disarticulation. Three Figure-of-Eight Walk Test conditions were investigated: 1) walking at a self-selected walking speed, 2) walking while carrying a tray with two cups of water, and 3) walking on uneven terrain. Internal consistency was evaluated using Cronbach's alpha. Convergent construct validity was examined by analysing the relationship between the Figure-of-Eight Walk Test parameters and performance-based parameters (Amputee Mobility Predictor, Ten-Meter Walk Test, Six-Minute Walk Test) and self-report measures (Prosthetic Limb Users Survey of Mobility, Activities-specific Balance Confidence Scale) using Spearman's rank-order correlations. Known-groups construct validity was assessed by comparing the Figure-of-Eight Walk Test parameters based on anatomical level of amputation. Friedman's test and post hoc analysis were used to examine differences between the walking conditions within each group. RESULTS: Cronbach's alpha coefficients of the Figure-of-Eight Walk Test parameters for all three conditions ranged from 0.89 to 0.99. The Figure-of-Eight Walk Test time and step parameters demonstrated moderate to good correlation (ρ = -0.50 to -0.77) for performance-based mobility measures. The correlations were stronger during Condition 3 in comparison with the original Figure-of-Eight Walk Test. The correlation was fair to good (ρ = -0.41 to -0.57) for the self-report mobility measures. Comparison between groups showed a difference between transtibial and transfemoral amputation/knee disarticulation participants when it comes to the Figure-of-Eight Walk Test time and smoothness parameters in Condition 2 (p < 0.05). Comparison between walking conditions within each group showed significant differences in the Figure-of-Eight Walk Test parameters in the two novel conditions in comparison with the original Figure-of-Eight Walk Test. The Figure-of-Eight Walk Test and the novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity. Future studies should further develop and standardise the smoothness scale to better quantify walking performance and assess the responsiveness and reliability (inter-rater and intra-rater) of the Figure-of-Eight Walk Test (time and steps) and the novel conditions, while studies on known-groups validity should include persons with a wider mobility range.IMPLICATIONS FOR REHABILITATIONFigure-of-Eight Walk Test with the two novel conditions, which include carrying a load and walking on uneven terrain, may help to provide meaningful information about walking ability in daily life.The two novel conditions pose different challenges to persons with lower limb amputation when compared to the original Figure-of-Eight Walk Test and underscore the relevance to assess mobility under challenging walking conditions.The Figure-of-Eight Walk Test and the two novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity.