Adaptations from the prosthetic and intact limb during standing on a sway-referenced support surface for transtibial prosthesis users

Abstract

Purpose: To investigate the bilateral postural adaptations as a result of standing on an increasingly unstable sway-referenced support surface with both the intact and prosthetic limb for transtibial prosthesis users (TPUs). Method: TPUs (n = 14) and matched controls (n = 14) stood quietly in multiple foot placement conditions (intact foot, prosthetic foot and both feet) on a sway-referenced support surface which matched surface rotation to the movement of the centre of pressure (CoP). Force and motion data were collected and used to analyse CoP mean position, displacement integral and force components under intact and prosthetic limbs. Results: Significant differences were found between prosthesis users and controls in CoP mean position in anteroposterior (1.5 (95% CI, 1.2-1.8) cm) and mediolateral directions (3.1 (95% CI, 0.5-5.7) cm. CoP displacement integrals were significantly different greater for prosthesis user group in the anteroposterior direction. Force components differences were found in all planes (anteroposterior: 0.6 (95% CI, 0.4-0.8 N); mediolateral: 0.1 (95% CI, 0.0-0.2 N & 0.3 (95% CI, 0.2-0.4) N, inferosuperior: 2.2 (95% CI, 1.4-3.0) N). Conclusions: TPUs have bilateral static and dynamic postural adaptations when standing on a swayreferenced support surface that is different to controls, and between prosthetic and intact sides. Results further support evidence highlighting importance of the intact limb in maintenance of postural control in prosthesis users. Differences indicate clinical treatment should be directed towards improving outcomes on the intact side. ä IMPLICATIONS FOR REHABILITATION Prosthesis users have bilateral adaptations when standing on a sway referenced support surface These adaptations are different to controls, and between prosthetic and intact sides. The intact limb is the major contributor to maintenance of postural control in prosthesis users. Clinical treatment should account for this when interventions are designed.

Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review

“…The results from the current study showed a large bias toward recruiting males in research in this area. The reported 26.4% of female lower limb prosthesis users participating in studies was lower than what has been reported in a highly regarded national amputation registry (SwedeAmp; 39%), 234 as well as in previous research (34.5%-38.4%) such as Claessen et al 235 and Ziegler-Graham et al 236 The present authors think it is noteworthy that, of the (n 5 161) articles reporting characteristics on sex in the balance articles in Supplemental Table (Supplemental Digital Content 2, http://links.lww.com/POI/A170) [12][13][14][19][20][21][22][23]25,26,28,29,[31][32][33][34][35][36][37][38][39][40][41][42]44,45,47,48,[50][51][52][53][54][55][56]58,59,[62][63][64][65][66][67]…”

“…79,92,94,108-113 The equipment used across studies varied, but the most common was multiple force plates (Figure 2). 12,19-48,51-60,62-70,114-117 Motion capture systems were also common. 13,20,21,29,31-36,41,44,45,48,51,54,60,90,91,99,100,102,108,110,112,113,115-138 Single force platforms were also commonly used in studies.…”

“…13,14,[19][20][21][22][23][24][71][72][73][74][75][76][77][78][79]114,[118][119][120][121]139,140,143,144,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][169][170][171][172][173][174][175][176][177][1...…”

Postural Control Strategies and Balance-Related Factors in Individuals with Traumatic Transtibial Amputations

“…After a TTA, most individuals rely automatically on their intact leg during standing [3][4][5][6] and walking [7,8]. This strategy is even more pronounced in situations with increased demands for postural control [3,5,[9][10][11][12][13].…”

Effect of standing and sitting positions on energy expenditure in people with transtibial amputation compared to age- and sex-matched controls

“…17,18 Displacement of the center of mass in people with lower-limb amputation is higher in both the anterior-posterior and medial-lateral directions compared with controls without amputation. 17,19 It has also been noted that balance in people with lower-limb amputation is maintained through increased movements of the nonamputated limb and trunk, 18 likely because of the loss of proprioception and ankle control on the prosthetic limb. Thus, the energy required to stand may be greater in people with than without amputation because increased postural sway and increased center of mass displacement will require greater muscular activation and metabolic effort to maintain the standing position.…”