Walking in an Unstable Environment: Strategies Used by Transtibial Amputees to Prevent Falling During Gait

Abstract

Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people.

Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment

“…Amputee gait is considered less stable than able-bodied due to loss of lower limb musculature and proprioception. Transtibial amputees typically have a more variable gait pattern and walk with shorter, wider steps and slower walking speeds, compared to able-bodied, for level and non-level surfaces [11][12][13][14][15][16]. Therefore, the ability to alter gait speed may be especially important for transtibial amputees when walking over more challenging surfaces.…”

“…However, Sloot et al only examined level treadmill walking for able-bodied participants. A recent study by Hak et al [10,11] examined ablebodied and transtibial amputee gait to determine if participants would reduce speed when walking on a self-paced treadmill with continuous medial-lateral translations. Participants did not reduce speed, but walked with shorter, wider, faster steps.…”

Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments

“…However, these patients did not exhibit increased local or orbital instability of their trunk (C7) movements compared to healthy controls (Beurskens et al, 2014). Two recent studies similarly found that persons with transtibial amputation exhibited either only slightly increased local instability of pelvic movements during perturbed walking (Hak et al, 2013) or slightly less dynamic instability of center of mass (sacrum) movements during normal running (Look et al, 2013). Thus, active persons with lower limb amputation appear to be able to achieve similar trunk stability as able bodied individuals.…”

Adapting to change : influence if a microprocessor-controlled prosthetic knee on gait adaptations

“…Hak et al studied the effect of continuous mediolateral balance perturbations on the gait of individuals with a transtibial amputation and without an amputation. 168 They found the balance perturbation led to a decrease in step length, increase in step frequency and increased backward margin of stability when compared to non-perturbed walking. 168 These results are in line with the results we found for the Rheo Knee II condition and the individuals without an amputation.…”

“…Hak et al found that both individuals with and without a transtibial amputation decreased step length and increased step frequency to increase stability when confronted with platform perturbations. 167,168 Decreasing step length could be difficult for individuals walking with a non-microprocessorcontrolled prosthetic knee as the knee has to be extended at the beginning of the stance phase to avoid knee buckling. Achieving full prosthetic knee extension requires a relatively large step length.…”