Balance control on a moving platform in unilateral lower limb amputees Vrieling, A. H.; van Keeken, H. G.; Schoppen, T.; Otten, E.; Hof, A. L.; Halbertsma, J. P. K.; Postema, K. AbstractObjective: To study balance control on a moving platform in lower limb amputees. Design: Observational cohort study. Participants: Unilateral transfemoral and transtibial amputees and able-bodied control subjects.Interventions: Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. Main outcome measures: Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift.Results: Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and nonaffected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. Conclusion:The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation. #

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Objective: To study the limitations in function and adjustment strategies of lower limb amputees in gait termination. Design: Observational cohort study. Setting: University Medical Centre. Participants: Unilateral transfemoral and transtibial amputees, and able-bodied control subjects. Main outcome measures: Leading limb preference, temporal variables, lower limb joint angles, ground reaction forces, and centre of pressure shift.Results: Compared to able-bodied subjects, amputees showed a decreased peak braking ground reaction force in the prosthetic limb, no anterior centre of pressure shift during leading with the prosthetic limb and an increased mediolateral centre of pressure shift. Amputees used several adjustment strategies to compensate for the limitations in function; leading limb preference for the non-affected limb, longer production of braking force in the non-affected limb, decreased gait termination velocity and more weight-bearing on the non-affected limb. Conclusion: Limitations in function and adjustment strategies were mainly similar in transfemoral and transtibial amputees. Due to the lack of active ankle function, amputees were not able to increase the braking force and to shift the centre of pressure anteriorly. Leading with the non-affected limb is favourable for adequate deceleration and balance control, but in daily life not always applicable. It is important that amputees are trained in gait termination during rehabilitation and prosthetic design should focus on a more active role of the prosthetic foot and knee. #