Effects of anterior-posterior shifts in prosthetic alignment on the sit-to-stand movement in people with a unilateral transtibial amputation

Abstract

The sit-to-stand movement can be challenging for people with a transtibial amputation (TTA). The alignment of the prosthesis may influence the movement strategies people with TTA use to transfer from sit-to-stand by affecting foot placement. The purpose of this study was to determine how shifting the prosthetic foot anterior and posterior relative to the socket affects movement strategies used to transfer from sit-to-stand. To aid in interpretation, we compared movement strategies between people with and without TTA. Nine people with TTA and nine sex-, and age-matched non-amputee controls completed five self-paced sit-to-stand trials. With the posterior alignment, participants with TTA had 1) smaller braking GRF impulse on the prosthetic side and greater impulse on the intact side compared to the anterior alignment, 2) no significant differences between sides, which suggests greater braking impulse symmetry compared to anterior and prescribed alignments, and 3) smaller axial trunk range of motion compared to the prescribed alignment. There were also differences between participants with TTA and controls in braking GRF impulse, knee extension moment, anterior/posterior center of pressure position, and lateral and axial trunk range of motion. Based on these results, shifting the prosthetic foot posterior to the socket may be a useful tool to reduce braking impulse asymmetry and trunk motion in people with TTA during sit-to-stand. Thus, prosthetic alignment can have important implications for the comfort and ability of people with TTA to transfer from sit-to-stand as well as for development of secondary health conditions like low back pain, which is associated with compensatory movements.