The relative contributions of the prosthetic and sound limb to balance control in unilateral transtibial amputees

In unilateral transtibial amputees maintenance of standing balance is compromised due to the lack of active ankle control in the prosthetic limb. The purpose of this study is to disentangle the contribution of the prosthetic and sound limb to balance control following waist-pull perturbations. We compared the contribution of the hip and ankle joints to balance control of 15 unilateral transtibial amputees and 13 able-bodied controls after been externally perturbed through release of a pulling force. Perturbations were applied in four different directions. Outcome measure was the proportion of joint moment integrated over time generated by the hip and ankle joints in order to restore static stability after perturbation. Analyses revealed that perturbations in backward/forward direction were recovered mainly by the ankle strategy. The amputees compensated for the absence of active ankle control in the prosthetic limb by increasing the ankle moment in the sound limb. Interestingly, the passive properties of the prosthetic foot contributed to balance control, which has important implications for prosthetic fitting and standing stability in lower limb amputees. Amputees and controls resisted perturbations in medio-lateral direction by generating the necessary hip moments. Finally, these findings are discussed with respect to prosthetic design and rehabilitation processes. (C) 2012 Elsevier B.V. All rights reserved.