title: Adaptation to altered balance conditions in unilateral amputees due to atherosclerosis: a randomized controlled study.
abstract: BACKGROUND
  Amputation impairs the ability to balance. We examined adaptation strategies in balance following dysvascularity-induced unilateral tibial amputation in skilled prosthetic users (SPU) and first fitted amputees (FFA) (N = 28).
  
  
  METHODS
  Excursions of center of pressure (COP) were determined during 20 s quiet standing using a stabilometry system with eyes-open on both legs or on the non-affected leg(s).
  
  
  METHODS
  COP trajectories and time functions; distribution of reaction forces between the two legs; inclination angles obtained through second order regression analysis using stabilogram data.
  
  
  RESULTS
  FFA vs SPU demonstrated 27.8% greater postural sway in bilateral stance (p = 0.0004). Postural sway area was smaller in FFA standing on the non-affected leg compared with SPU (p = 0.028). The slope of the regression line indicating postural stability was nearly identical in FFA and SPU and the direction of regression line was opposite for the left and right leg amputees.
  
  
  CONCLUSIONS
  Of the two adaptation strategies in balance, the first appears before amputation due to pain and fatigue in the affected leg. This strategy appears in the form of reduced postural sway while standing on the non-affected leg. The second adaptation occurs during rehabilitation and regular use of the prosthesis resulting in normal weightbearing associated with reduced postural sway on two legs and return to the normal postural stability on one leg.
authors: St. George University Teaching Hospital, Physiotherapy, Székesfehérvár, Hungary. mayer.agnes@chello.hu
authors: Agnes
authors: A
authors: Mayer
authors: József
authors: J
authors: Tihanyi
authors: Károly
authors: K
authors: Bretz
authors: Zsolt
authors: Z
authors: Csende
authors: Eva
authors: E
authors: Bretz
authors: Mónika
authors: M
authors: Horváth
references: Am J Phys Med Rehabil. 2009 Nov;88(11):896-903
references: 19661773
references: J Vasc Surg. 2004 Mar;39(3):523-30
references: 14981443
references: J Biomech. 2005 Oct;38(10):2037-49
references: 16084204
references: Arch Intern Med. 2006 Oct 9;166(18):1986-92
references: 17030832
references: Prosthet Orthot Int. 1986 Dec;10(3):139-41
references: 3808919
references: Gait Posture. 2008 Apr;27(3):471-7
references: 17644336
references: Scand J Rehabil Med. 1992;24(2):83-90
references: 1604266
references: Gait Posture. 2008 Aug;28(2):222-8
references: 18207407
references: J Bone Joint Surg Am. 1978 Oct;60(7):895-8
references: 701337
references: Gait Posture. 2009 Apr;29(3):437-43
references: 19070493
references: J Gerontol A Biol Sci Med Sci. 2001 Jul;56(7):M454-8
references: 11445605
references: Prosthet Orthot Int. 1994 Dec;18(3):150-8
references: 7724348
references: Clin Biomech (Bristol, Avon). 1997 Jan;12(1):52-59
references: 11415672
references: Aging Clin Exp Res. 2008 Dec;20(6):540-6
references: 19179838
references: Hum Mov Sci. 2003 Aug;22(3):221-36
references: 12967755
references: J Neurophysiol. 1996 Jun;75(6):2334-43
references: 8793746
references: J Appl Biomech. 2007 Feb;23(1):63-9
references: 17585173
references: Am J Phys Med Rehabil. 2002 Jan;81(1):13-20
references: 11807327
references: Arch Phys Med Rehabil. 2005 Apr;86(4):633-40
references: 15827911
references: J Physiol. 2003 Aug 15;551(Pt 1):357-70
references: 12832494
references: J Am Geriatr Soc. 2000 Feb;48(2):131-8
references: 10682941
references: Prosthet Orthot Int. 1984 Dec;8(3):159-64
references: 6522259
references: Arch Phys Med Rehabil. 2003 May;84(5):683-6
references: 12736881
references: Prosthet Orthot Int. 1987 Apr;11(1):33-9
references: 3588262
references: Aging Clin Exp Res. 2002 Feb;14(1):42-6
references: 12027151
references: Prosthet Orthot Int. 1992 Dec;16(3):200-2
references: 1491955
references: Phys Ther. 1998 Jun;78(6):577-92
references: 9626270
references: Stroke. 2008 Jun;39(6):1793-9
references: 18369174