Sheehan Riley C, Beltran Eduardo J, Dingwell Jonathan B, Wilken Jason M
Department of Kinesiology & Health Education, University of Texas, Austin, TX 78712, USA; Military Performance Lab, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft. Sam Houston, TX 78234, USA.
Military Performance Lab, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft. Sam Houston, TX 78234, USA.
Gait Posture. 2015 Mar;41(3):795-800. doi: 10.1016/j.gaitpost.2015.02.008. Epub 2015 Feb 27.
Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk. This study determined how lateral walking surface perturbations affected the regulation of whole body and individual leg angular momentum in able-bodied controls and individuals with unilateral transtibial amputation. Participants walked at fixed speed in a Computer Assisted Rehabilitation Environment with no perturbations and continuous, pseudo-random, mediolateral platform oscillations. Both the ranges and variability of angular momentum for both the whole body and both legs were significantly greater (p<0.001) during platform oscillations. There were no significant differences between groups in whole body angular momentum range or variability during unperturbed walking. The range of frontal plane angular momentum was significantly greater for those with amputation than for controls for all segments (p<0.05). For the whole body and intact leg, angular momentum ranges were greater for patients with amputation. However, for the prosthetic leg, angular momentum ranges were less for patients than controls. Patients with amputation were significantly more affected by the perturbations. Though patients with amputation were able to maintain similar patterns of whole body angular momentum during unperturbed walking, they were more highly destabilized by the walking surface perturbations. Individuals with transtibial amputation appear to predominantly use altered motion of the intact limb to maintain mediolateral stability.
超过50%的下肢截肢者每年至少跌倒一次。这些人对额面稳定性挑战的有效应对能力也有所下降。全身角动量的范围与稳定性和跌倒风险相关。本研究确定了在健全对照组和单侧胫部截肢者中，横向行走表面扰动如何影响全身和单条腿的角动量调节。参与者在计算机辅助康复环境中以固定速度行走，期间无扰动以及存在连续、伪随机的内外侧平台振荡。在平台振荡期间，全身和双腿的角动量范围及变异性均显著更大（p<0.001）。在无扰动行走期间，两组在全身角动量范围或变异性方面无显著差异。对于所有节段，截肢者的额面角动量范围显著大于对照组（p<0.05）。对于全身和健全腿，截肢患者的角动量范围更大。然而，对于假肢腿，患者的角动量范围小于对照组。截肢患者受扰动的影响明显更大。尽管截肢患者在无扰动行走期间能够保持类似的全身角动量模式，但行走表面扰动使其更易失去稳定性。胫部截肢者似乎主要通过改变健全肢体的运动来维持内外侧稳定性。
