Balance control on a moving platform in unilateral lower limb amputees Vrieling, A. H.; van Keeken, H. G.; Schoppen, T.; Otten, E.; Hof, A. L.; Halbertsma, J. P. K.; Postema, K. AbstractObjective: To study balance control on a moving platform in lower limb amputees. Design: Observational cohort study. Participants: Unilateral transfemoral and transtibial amputees and able-bodied control subjects.Interventions: Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. Main outcome measures: Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift.Results: Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and nonaffected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. Conclusion:The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation. #

Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.

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