Margins of stability of persons with transtibial or transfemoral amputations walking on sloped surfaces

Abstract

Gait is a complex motor skill. However, most falls in humans occur during gait, and people with lower limb amputation have an increased risk of falls. Thus, this study evaluated the stability of persons with unilateral amputation by quantifying the margin of stability (MoS) during gait, to contribute to understanding the strategies adopted by these people to reduce falls. The participants were divided into 3 groups: persons with transtibial amputations (n = 12, 32.27 ± 10.10 years, 76.9 ± 10.3 kg, 1.74 ± 0.06 m); persons with transfemoral amputations (n = 13, 32.21 ± 8.34 years, 72.55 ± 10.23 kg, 1.73 ± 0.05 m); and controls (n = 15, 32.2 ± 10.17 years, 75.4 ± 9.25 kg, 1.75 ± 0.05 m), who walked for 4 min on a level and sloped (8% down and up) treadmill. The pelvic and foot marker kinematic data were used to estimate the center of mass and base of support, and from these, the MoS was estimated. Although both groups of persons with amputations showed higher values for the ML MoS than did the control group (transtibial: 8.81 ± 1.79, 8.97 ± 1.74, 8.79 ± 1.76, transfemoral: 10.15 ± 2.03, 10.60 ± 1.98, 10.11 ± 1.75, control: 8.13 ± 1.30, 7.18 ± 1.85, 8.15 ± 1.57, level, down, and up, respectively), only the transfemoral group presented a significant higher value compared to the control group. Our findings suggest that the documented limitations in persons with amputations, especially with transfemoral amputation, are exacerbated in situations that require more skills, such as walking on sloped surfaces, triggering protective mechanisms.