The effects of walking speed and an uneven surface on dynamic stability margins in young adult subjects with and without traumatic unilateral trans-tibial amputations

Scott, Shawn James
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Dynamic stability is commonly defined as the ability to maintain balance through center of mass control during locomotion. Patients with locomotor impairments are especially challenged when walking over uneven surfaces (Richardson 2004). We studied dynamic stability margins in young healthy adults and in adults with unilateral traumatic trans-tibial amputations (TTA). To date, studies have not controlled for walking speed over an uneven surface in a patient population. We hypothesized that: 1) DSMs would increase over the uneven rocky surface (URS) for both groups, 2) DSMs would be greater on the involved side at faster walking speeds for subjects with TTA and, 3) DSMs would increase more for the involved limb when on the URS. 17 (4 females, 13 males) young healthy military service members (22.8 ± 6.4 years) and 12 (1 female, 11 males) service members (27.2 ± 4.7 years) with traumatic unilateral trans-tibial amputations participated in two study designs. A 15-segment model was used to estimate whole body COM motions. All subjects walked at 5 dimensionless speeds over a flat level surface (FLS) and an URS. Subjects completed 6-10 trials over each surface at each speed. Minimum frontal plane DSM values were extracted for each stride for statistical analyses. For young healthy subjects a two factor (speed x surface) ANOVA was used to test significance (p<.05). The DSMs were not greater over the URS (p=.307), but a main effect due to speed was found (p<.001) for young healthy subjects. In contrast, DSMs were significantly larger when subjects with TTA walked on the URS compared to the FLS (p = 0.011). For subjects with unilateral TTA, a three-factor ANCOVA ((amputation) side x speed x surface) with residual limb length (p=.029) and time in prosthesis (p=.741) as covariates was used for hypothesis testing. When limb length and time in prosthesis were accounted for there was no significant within subjects effect due to speed (p=.656). There were no significant differences between involved and uninvolved limbs (p = 0.211). There were no significant interaction effects. In conclusion, there was a difference in DSMs due to speed in unimpaired subjects and due to surface and residual limb length in subjects with unilateral TTAs. In subjects with unilateral TTA side-to-side symmetry was found for DSM measures, which was in contrast to an earlier study of subjects with unilateral trans-femoral amputations (Hof 2006). It appears that symmetry and dynamic stability are reasonable expectations for young adults with isolated TTAs.