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Related Experiment Video

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Sit-to-stand-and-walk from 120% Knee Height: A Novel Approach to Assess Dynamic Postural Control Independent of Lead-limb
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How persons with transtibial amputation regulate lateral stepping while walking in laterally destabilizing

Jonathan B Dingwell1, Joseph P Cusumano2, Jonathan H Rylander3

  • 1Department of Kinesiology & Health Education, University of Texas, Austin, TX, USA.

Gait & Posture
|October 25, 2020
PubMed
Summary

Persons with transtibial amputation (TTA) regulate lateral stepping similarly to able-bodied individuals, even during destabilizing perturbations. This suggests amputation has minimal impact on their ability to maintain balance while walking.

Keywords:
AmputationEquifinalityMotor controlRedundancyVariabilityWalking

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Area of Science:

  • Biomechanics
  • Neuroscience
  • Rehabilitation Science

Background:

  • Lower limb amputation often leads to reduced physical capacity, gait instability, and increased fall risk.
  • Effective regulation of stepping movements is crucial for balance recovery and fall prevention in individuals with amputation.
  • Understanding how persons with amputation regulate stepping is critical for developing targeted interventions.

Purpose of the Study:

  • To investigate whether individuals with transtibial amputation (TTA) exhibit impaired lateral stepping regulation compared to able-bodied (AB) individuals under destabilizing conditions.
  • To determine if TTA individuals utilize similar or different strategies for lateral stepping control when facing perturbations.

Main Methods:

  • Eight individuals with unilateral TTA and thirteen AB controls walked in a virtual environment with and without lateral perturbations (oscillating visual field, oscillating treadmill).
  • Analysis included step width and lateral body position time series, calculating means, standard deviations, and Detrended Fluctuation Analysis (DFA) scaling exponents.
  • Direct step-to-step corrections for width and position deviations were quantified and compared to computational model predictions.

Main Results:

  • All participants showed increased variability, decreased DFA scaling exponents, and tighter direct control when perturbed.
  • Simulations indicated that participants responded to perturbations by increasing control over step width and lateral position.
  • Individuals with TTA demonstrated only minor differences in lateral stepping regulation compared to AB individuals, even under significant destabilization.

Conclusions:

  • Lateral stepping regulation in individuals with TTA is largely comparable to that of able-bodied individuals, even when challenged with destabilizing perturbations.
  • The findings suggest that existing stepping regulation strategies are robust and adaptable in the TTA population.
  • Future interventions to reduce fall risk in amputees should consider multi-objective control strategies, mirroring the intrinsic nature of stepping regulation.