Asymmetrical loading demands associated with vertical jump landings in people with unilateral transtibial amputation

Abstract

Loading symmetry during vertical jump landings between a person with amputation's intact and prosthetic limbs was assessed to determine the role of each limb in controlling the downward momentum of the center of mass during landing. Six participants with unilateral transtibial amputation (TTA) and ten nondisabled participants completed 10 maximal vertical jumps, of which the highest jump was analyzed. Contralateral symmetry was assessed through the Symmetry Index (SI), while symmetry at the group level was assessed through a Mann-Whitney U test. Participants with TTA performed quasi-unilateral landings onto the intact limbs, resulting from either the incapability of the prosthetic ankle to plantar flex or increased residual-limb knee and hip flexion. In the loading phase, the participants with TTA displayed reduced prosthetic-side peak vertical forces (p = 0.04) along with reduced prosthetic-side ankle range of motion (p < 0.001), extensor moments (p = 0.03), and negative work generated (p = 0.00). Individual asymmetries were evident in the peak vertical force magnitudes (SI = 51%-140%), duration from touchdown to peak vertical force (SI = 52%-157%), ankle joint angles at touchdown (SI = 100%-538%), ranges of motion (SI = 147%-200%), knee (SI = 66%-179%) and hip (SI = 87%-132%) extensor moments, and work done at the ankle (SI = 155%-199%) and hip (SI = 83%-204%). High peak forces (25.25 +/- 4.89 N·kg(-1) intact limb and 14.61 +/- 8.28 N·kg(-1) prosthetic limb) from significantly lower (p < 0.001) landing heights than the nondisabled participants indicate a potential injury risk associated with landing for people with TTA.