Document Detail

High failure rates when avoiding obstacles during treadmill walking in patients with a transtibial amputation.
MedLine Citation:
PMID:  16876558     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate if and to what extent patients with a transtibial amputation are less successful in avoiding unexpected obstacles while walking than healthy adults. DESIGN: Experimental 2-group design. SETTING: Dutch rehabilitation center. PARTICIPANTS: Eleven patients with a transtibial amputation and 14 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects walked on a treadmill at .56m/s. In 2 series of 12 trials each, an obstacle was dropped in front of the prosthetic or the nonprosthetic leg of the amputation group and the left leg of the control group at different phases during the step cycle. It was noted which avoidance strategy was used (a long step strategy [LSS] or a short step strategy [SSS]) and whether the obstacle was avoided successfully or not. These data were expressed as a percentage of the total number of trials completed by each subject. RESULTS: With either leg, the amputation group made significantly more errors than the control subjects (prosthetic leg, 24%+/-17%; nonprosthetic leg, 21%+/-17% vs 2%+/-2% for the control group). Highest failure rates were in the amputation group when time pressure was high, requiring an SSS, especially on the prosthetic side. An LSS under time pressure, however, nearly always resulted in failure for both the prosthetic and nonprosthetic legs. Subjects with the longest time since amputation were most successful in avoiding unexpected obstacles. CONCLUSIONS: Under time pressure, patients with a lower-leg prosthesis perform best when they use their nonprosthetic leg as the lead limb in an SSS. The fact that some subjects with the longest time since amputation made no errors suggests that over many years it is possible to relearn the appropriate avoidance reactions sufficiently fast.
Cheriel J Hofstad; Harmen van der Linde; Bart Nienhuis; Vivian Weerdesteyn; Jacques Duysens; Alexander C Geurts
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of physical medicine and rehabilitation     Volume:  87     ISSN:  0003-9993     ISO Abbreviation:  Arch Phys Med Rehabil     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2006-09-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2985158R     Medline TA:  Arch Phys Med Rehabil     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1115-22     Citation Subset:  AIM; IM    
Sint Maartenskliniek Research Development & Education, Nijmegen, The Netherlands.
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MeSH Terms
Analysis of Variance
Artificial Limbs*
Case-Control Studies
Middle Aged
Statistics, Nonparametric
Tibia / surgery*
Walking / physiology*

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