Walking in an unstable environment: Strategies used by transtibial amputees to prevent falling during gait

L. Hak, J.H. van Dieen, P. van der Wurff, M.R. Prins, A. Mert, P.J. Beek, J.H.P. Houdijk

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls. Design: Cross-sectional study. Setting: An instrumented treadmill mounted onto a 6°-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9). Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees. Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]). Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups. Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. © 2013 by the American Congress of Rehabilitation Medicine.
    LanguageEnglish
    Pages2186-2193
    Number of pages8
    JournalArchives of Physical Medicine and Rehabilitation
    Volume94
    Issue number11
    DOIs
    StatePublished - 2013

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    Accidental Falls
    Amputees
    Gait
    Walking
    Knee
    Cross-Sectional Studies
    Outcome Assessment (Health Care)

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    @article{92f1462854114984b0b8dec8c79c86df,
    title = "Walking in an unstable environment: Strategies used by transtibial amputees to prevent falling during gait",
    abstract = "Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls. Design: Cross-sectional study. Setting: An instrumented treadmill mounted onto a 6°-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9). Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees. Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]). Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups. Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. {\circledC} 2013 by the American Congress of Rehabilitation Medicine.",
    author = "L. Hak and {van Dieen}, J.H. and {van der Wurff}, P. and M.R. Prins and A. Mert and P.J. Beek and J.H.P. Houdijk",
    year = "2013",
    doi = "10.1016/j.apmr.2013.07.020",
    language = "English",
    volume = "94",
    pages = "2186--2193",
    journal = "Archives of Physical Medicine and Rehabilitation",
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    Walking in an unstable environment: Strategies used by transtibial amputees to prevent falling during gait. / Hak, L.; van Dieen, J.H.; van der Wurff, P.; Prins, M.R.; Mert, A.; Beek, P.J.; Houdijk, J.H.P.

    In: Archives of Physical Medicine and Rehabilitation, Vol. 94, No. 11, 2013, p. 2186-2193.

    Research output: Contribution to JournalArticleAcademicpeer-review

    TY - JOUR

    T1 - Walking in an unstable environment: Strategies used by transtibial amputees to prevent falling during gait

    AU - Hak,L.

    AU - van Dieen,J.H.

    AU - van der Wurff,P.

    AU - Prins,M.R.

    AU - Mert,A.

    AU - Beek,P.J.

    AU - Houdijk,J.H.P.

    PY - 2013

    Y1 - 2013

    N2 - Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls. Design: Cross-sectional study. Setting: An instrumented treadmill mounted onto a 6°-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9). Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees. Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]). Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups. Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. © 2013 by the American Congress of Rehabilitation Medicine.

    AB - Objective: To investigate which strategies transtibial amputees use to cope with challenges of gait stability and gait adaptability, and how these strategies differ from strategies used by able-bodied controls. Design: Cross-sectional study. Setting: An instrumented treadmill mounted onto a 6°-of-freedom motion platform in combination with a virtual environment. Participants: Transtibial amputees (n=10) and able-bodied controls (n=9). Interventions: Mediolateral (ML) translations of the walking surface were imposed to manipulate gait stability. To provoke an adaptive gait pattern, a gait adaptability task was used in which subjects had to hit virtual targets with markers guided by their knees. Main Outcome Measures: Walking speed, step length, step frequency, step width, and selected measures of gait stability (short-term Lyapunov exponents and backward and ML margins of stability [MoS]). Results: Amputees walked slower than able-bodied people, with a lower step frequency and wider steps. This resulted in a larger ML MoS but a smaller backward MoS for amputees. In response to the balance perturbation, both groups decreased step length and increased step frequency and step width. Walking speed did not change significantly in response to the perturbation. These adaptations induced an increase in ML and backward MoS. To perform the gait adaptability task, both groups decreased step length and increased step width, but did not change step frequency and walking speed. ML and backward MoS were maintained in both groups. Conclusions: Transtibial amputees have the capacity to use the same strategies to deal with challenges of gait stability and adaptability, to the same extent as able-bodied people. © 2013 by the American Congress of Rehabilitation Medicine.

    U2 - 10.1016/j.apmr.2013.07.020

    DO - 10.1016/j.apmr.2013.07.020

    M3 - Article

    VL - 94

    SP - 2186

    EP - 2193

    JO - Archives of Physical Medicine and Rehabilitation

    T2 - Archives of Physical Medicine and Rehabilitation

    JF - Archives of Physical Medicine and Rehabilitation

    SN - 0003-9993

    IS - 11

    ER -