Postural responses during volitional and perturbed dynamic balance tasks in new lower limb amputees: A longitudinal study

This study examined the adaptation of postural responses in transtibial amputees during both perturbed and volitional dynamic balance tasks during a five-month period following discharge from inpatient rehabilitation. Seven unilateral transtibial amputees performed the sensory organisation test (SOT) and the limits of stability (LOS) test protocols on the NeuroCom Equitest® at one, three and six months post-discharge from in-patient rehabilitation. Overall balance ability improved significantly (p = 0.01) following discharge as did utilisation of somatosensory input (p = 0.01), with hip strategy use decreasing. Reaction time and movement velocity did not change significantly in the majority of target directions for the LOS test. However, endpoint COG excursion and directional control were significantly increased in a number of directions (p ≤ 0.05). Although balance ability improved following discharge from rehabilitation, participants were heavily reliant upon vision in order to maintain balance. Following discharge from rehabilitation, amputees were seemingly able to increase the spatial and accuracy aspects of volitional exploration of their LOS. However, temporal aspects did not display any adaptation, suggesting a trade-off between these aspects of postural control. Further practice of performing volitional postural movements under increasing time pressure, for example using low-cost gaming tools, may improve balance ability and postural control.

► Postural responses during balance tasks in new transtibial amputees following discharge from rehabilitation were examined. ► Amputees increased utilisation of the ankle strategy and somatosensory input. ► Despite improvements, amputees were heavily reliant upon vision to maintain balance. ► Amputees increased the spatial and accuracy aspects but not temporal aspects of postural control, suggesting a trade-off. ► These results have important implications for amputee postural control and rehabilitation.