Acta Univ. Palacki. Olomuc., Gymn. 2009 39(3): 51-59

Assessment of postural stability in patients with a transtibial amputation with various times of prosthesis use

Dagmar Kozáková¹, Zdeněk Svoboda¹, Miroslav Janura¹, Milan Elfmark¹, Ilona Nedvědová²

¹ Faculty of Physical Culture, Palacky University, Olomouc

² Rehabilitation centre Chuchelná, Chuchelná

Background: Postural confidence is an initial precondition for all activities within the activity of daily living. Subjects with lower limb amputation have, due to somatosensory loss of information from the lower limb, more difficult conditions for maintaining postural stability in comparison with healthy subjects. Early prosthetic fitting with a prosthesis (with regard to amputation level, health state, financial claims, etc.) is crucial for amputee reintegration into daily life.

Objective: The aim of this study was to assess the selected biomechanical parameters of standing stability in patients with a transtibial lower limb amputation with various times of prosthesis use. The next aim was to assess how the waiting time for the prosthesis fitting influences standing stability in different situations.

Methods: The tested group was made up of 21 patients (the average age was 64.4 ± 9.18 years) with a unilateral transtibial amputation. The reason for amputation was in the case of 12 tested patients a vascular disease, in 8 patients trauma and in one it was a tumor. The average length of prosthesis use was 156.4 ± 359.6 days. A right side transtibial amputation had been performed on 10 patients and on the left side in 11 patients. To define the basic parameters of postural stability, two force plates of the Kistler (type 9286AA) were used. Stability was tested for 30 seconds in 4 standing positions (natural bipedal stand, bipedal stand with a narrow base, natural bipedal stand with closed eyes and standing on foam). For an influence assessment of the period of prosthesis use on the level of postural stability, correlation analysis was used. The difference between each standing modification was analysed by ANOVA for repeated measurements and LSD post hoc test.

Results: In all tested situations, the loading of the sound limb is greater compared to the prosthetic limb in patients with a transtibial amputation (from 17.8% to 22.8%). This is also valid for COP sways in a mediolateral direction and for COP movement velocity in both anteroposterior and mediolateral directions (p < 0.01, p < 0.05). We did not find differences between all the tested standing modifications (except for the natural bipedal standing position) in sways and COP velocity movements. With a prolonged period of waiting for a prosthesis fitting we can observe an enlarged asymmetry of body weight distribution between the legs and also a higher range of COP sway and velocity.

Conclusions: In all measurements in patients with a transtibial amputation, our results show a greater loading on the sound limb compared to the prosthetic one. Faster prosthesis fitting decreases asymmetry from body weight distribution between both of the legs. The basic goal of achieving full value life in patients after lower limb amputation is a tendency towards early prosthesis fitting.

Keywords: Balance, lower limb amputation, posturography, weight bearing symmetry

Prepublished online: February 3, 2010; Published: June 1, 2009  Show citation