Dynamic balancing responses in unilateral transtibial amputees following outward-directed perturbations during slow treadmill walking differ considerably for amputated and non-amputated side.
Dynamic balancing responses in unilateral transtibial amputees following outward-directed perturbations during slow treadmill walking differ considerably for amputated and non-amputated side.
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DOI：
10.1186/s12984-021-00914-3
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发表时间：
2021-07-31
影响因子：
5.1
通讯作者：
Matjačić Z
中科院分区：
文献类型：
--
作者：
Olenšek A;Zadravec M;Burger H;Matjačić Z
由于运动和本体感受功能受损，下肢截肢对平衡提出了相当大的挑战，并大大增加了行走过程中出现扰动时摔倒的风险。本研究的目的是调查动态平衡反应在单侧transtibial截肢者时，他们受到扰动推动骨盆在向外的方向上的时间，在他们的非截肢和截肢侧在缓慢行走的脚罢工。14例单侧经胫骨截肢受试者和9例对照受试者参加了研究。在左腿或右腿的脚撞击时，他们受到传递到骨盆的扰动。我们记录了压力中心和质量中心的轨迹，站立和跨步周期的持续时间以及地面反作用力。进行统计分析，以确定对照受试者和截肢受试者之间的动态平衡反应的显着差异时，受到向外定向扰动后，进入他们的非截肢或截肢侧的立场阶段。当在非截肢腿的脚撞击时提供向外定向的扰动时，截肢受试者能够与对照受试者类似地调节压力中心和地面反作用力，这表明即时平衡策略的应用。另一方面，当截肢腿进入站立相时，当施加扰动时，完全缺乏站立反应。截肢的受试者在随后的站立阶段使用步进策略并调整非截肢腿的位置以进行交叉步。这样的响应导致显著更大的质心位移。本研究的结果表明，由于COP调制机制，这是通常由踝关节运动功能的情况下，人与单侧经胫骨截肢被迫选择步进策略，而不是立场的战略时，他们受到截肢侧的外向扰动。然而，步进响应的效率低于瞬时响应。
Due to disrupted motor and proprioceptive function, lower limb amputation imposes considerable challenges associated with balance and greatly increases risk of falling in presence of perturbations during walking. The aim of this study was to investigate dynamic balancing responses in unilateral transtibial amputees when they were subjected to perturbing pushes to the pelvis in outward direction at the time of foot strike on their non-amputated and amputated side during slow walking. Fourteen subjects with unilateral transtibial amputation and nine control subjects participated in the study. They were subjected to perturbations that were delivered to the pelvis at the time of foot strike of either the left or right leg. We recorded trajectories of center of pressure and center of mass, durations of in-stance and stepping periods as well as ground reaction forces. Statistical analysis was performed to determine significant differences in dynamic balancing responses between control subjects and subjects with amputation when subjected to outward-directed perturbation upon entering stance phases on their non-amputated or amputated sides. When outward-directed perturbations were delivered at the time of foot strike of the non-amputated leg, subjects with amputation were able to modulate center of pressure and ground reaction force similarly as control subjects which indicates application of in-stance balancing strategies. On the other hand, there was a complete lack of in-stance response when perturbations were delivered when the amputated leg entered the stance phase. Subjects with amputations instead used the stepping strategy and adjusted placement of the non-amputated leg in the ensuing stance phase to make a cross-step. Such response resulted in significantly larger displacement of center of mass. Results of this study suggest that due to the absence of the COP modulation mechanism, which is normally supplied by ankle motor function, people with unilateral transtibial amputation are compelled to choose the stepping strategy over in-stance strategy when they are subjected to outward-directed perturbation on the amputated side. However, the stepping response is less efficient than in-stance response.
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