Trunk and pelvic dynamics during transient turns among individuals with unilateral traumatic lower limb amputation

Abstract

Prior work has identified alterations in trunk-pelvic dynamics with lower limb amputation (LLA) during in-line walking; however, evaluations of other ambulatory tasks are limited. Turns are ubiquitous in daily life but can be challenging for individuals with LLA, prompting additional or unique proximal compensations when changing direction, which over time may lead to development of low back pain. We hypothesized such proximal kinematic differences between persons with and without LLA would exist in the sagittal and frontal planes. Three-dimensional trunk and pelvic kinematics, translational and rotational momenta, and coordination phase/variability were compared among eight persons with unilateral LLA (4 with transfemoral amputation and 4 with transtibial amputation), and five uninjured controls, who performed 90-degree turns to the left (n = 10) and right (n = 10). Participants self-selected the turn strategy (i.e., step vs. spin) and pivot limb in response to verbal cues regarding when and which direction to turn. Coordination variability and translational angular momenta did not differ between groups in either turn type. During spin turns, frontal rotational angular momenta were larger and frontal trunk-pelvis range of motion was smaller among persons with vs. without LLA. During step turns, pelvis leading transverse coordination was more frequent, frontal trunk rotational angular momentum was smaller, and sagittal pelvis range of motion was larger among persons with vs. without LLA. Altered and task-dependent modulation of trunk-pelvic dynamics among persons with LLA provides additional support for a potential link between repeated exposures to altered trunk-pelvic dynamics with elevated low back pain risk.