Locomotor adaptability in persons with unilateral transtibial amputation

Abstract

BackgroundLocomotor adaptation enables walkers to modify strategies when faced with challenging walking conditions. While a variety of neurological injuries can impair locomotor adaptability, the effect of a lower extremity amputation on adaptability is poorly understood.ObjectiveDetermine if locomotor adaptability is impaired in persons with unilateral transtibial amputation (TTA).MethodsThe locomotor adaptability of 10 persons with a TTA and 8 persons without an amputation was tested while walking on a split-belt treadmill with the parallel belts running at the same (tied) or different (split) speeds. In the split condition, participants walked for 15 minutes with the respective belts moving at 0.5 m/s and 1.5 m/s. Temporal spatial symmetry measures were used to evaluate reactive accommodations to the perturbation, and the adaptive/de-adaptive response.ResultsPersons with TTA and the reference group of persons without amputation both demonstrated highly symmetric walking at baseline. During the split adaptation and tied post-adaptation walking both groups responded with the expected reactive accommodations. Likewise, adaptive and de-adaptive responses were observed. The magnitude and rate of change in the adaptive and de-adaptive responses were similar for persons with TTA and those without an amputation. Furthermore, adaptability was no different based on belt assignment for the prosthetic limb during split adaptation walking.ConclusionsReactive changes and locomotor adaptation in response to a challenging and novel walking condition were similar in persons with TTA to those without an amputation. Results suggest persons with TTA have the capacity to modify locomotor strategies to meet the demands of most walking conditions despite challenges imposed by an amputation and use of a prosthetic limb.

The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study

“…During each phase, participants wore a safety harness and handrail use was allowed, similarly to methods outlined in past studies. 3,17 Additionally, each individual viewed a television monitor placed directly This complete timeline (Fig. 1) included a split-belt condition long enough for adaptation to occur, and a postadaptation condition in which the adaptive changes developed during split-belt walking "wash out," such that the individual walks similarly to baseline.…”

“…3 Researchers have also investigated locomotor adaptability in patient populations, including patients with cerebral vascular accident, 14 Parkinson's disease, 15 and transtibial amputation. [16][17][18] Patients with transtibial amputation were found to adapt similarly to individuals with no impairment. 17 Split-belt treadmill walking was reported as a rehabilitation intervention to correct temporal-spatial asymmetry in persons following stroke, 14 with benefits retained for at least 3 months.…”

“…[16][17][18] Patients with transtibial amputation were found to adapt similarly to individuals with no impairment. 17 Split-belt treadmill walking was reported as a rehabilitation intervention to correct temporal-spatial asymmetry in persons following stroke, 14 with benefits retained for at least 3 months. [19][20][21] However, the relationship between temporal-spatial changes and metabolic economy in a patient population has not been examined and there is no conclusive evidence suggesting changes in gait symmetry affect energy expenditure in individuals with lower-extremity amputation.…”

Unilateral step training can drive faster learning of novel gait patterns

“…Over time, people adapt to walk with symmetric steps despite the asymmetry in belt speeds 4 , 12 , 15 , and learning is quantified by measuring the gradual decrease in step length asymmetry. Prior studies have used this paradigm to understand how various clinical conditions affect locomotor learning 6 , 16 – 22 and to design new rehabilitation approaches for persons post-stroke 1 , 23 .…”

People can learn new walking patterns without walking

“…Prior studies have used this paradigm to understand how various clinical conditions affect locomotor learning (Choi et al, 2009;Darter et al, 2017;Dietz et al, 1995;Morton and Bastian, 2006;Reisman et al, 2007;Roemmich et al, 2014;Roper et al, 2019;Vasudevan et al, 2014) and to design new rehabilitation approaches for persons post-stroke (Reisman et al, 2013(Reisman et al, , 2010.…”