The ins and outs of dynamic balance during 90-degree turns in people with a unilateral transtibial amputation

Abstract

The ability to maintain balance when turning is essential to functional and independent living. Due to the lack of neuromuscular ankle control on the prosthetic side in people with a transtibial amputation (TTA), turning is likely more challenging. The purpose of this study was to quantify how people with TTA maintain dynamic balance during 90-degree turns made with the prosthesis on the inside and outside of the turn compared to people without amputation. Eight participants with TTA and eight age-, height-, and sex- matched non-amputee controls performed left and right 90-degree step turns at a self-selected speed. The primary outcomes were range of whole-body angular momentum and positive and negative contributions of six segment groups (head/trunk, pelvis, arms, and legs) to whole-body angular momentum during the continuation stride. Participants with TTA had greater range of frontal- and sagittal-plane whole-body angular momentum when turning with the prosthesis on the inside compared controls. They also had a greater range of whole-body angular momentum in all planes of motion when turning with the prosthesis on the inside compared to outside of the turn. The contributions for the head/trunk and inside and outside legs differed between groups and turns, suggesting altered interactions between segment momenta to compensate for the reduced contribution of the amputated leg. This study provides insight into possible training paradigms to reduce the high incidence of turn related falls in people with TTA and, potentially, ways to alter prosthetic function to promote balance control.