title: Can external lateral stabilization reduce the energy cost of walking in persons with a lower limb amputation?
abstract: The aim of this study was to examine whether impaired balance control is partly responsible for the increased energy cost of walking in persons with a lower limb amputation (LLA). Previous studies used external lateral stabilization to evaluate the energy cost for balance control; this caused a decrease in energy cost, with concomitant decreases in mean and variability of step width. Using a similar set-up, we expected larger decreases for LLA than able-bodied controls. Fifteen transtibial amputees (TT), 12 transfemoral amputees (TF), and 15 able-bodied controls (CO) walked with and without external lateral stabilization provided via spring like cords attached to the waist. Effects of this manipulation on energy cost, step parameters, and pelvic motion were evaluated between groups. TT (-5%) and CO (-3%) showed on average a small reduction in energy cost when walking with stabilization, whereas TF exhibited an increase in energy cost (+6.5%) The difference in the effect of stabilization was only significant between TT and TF. Step width, step width variability, and medio-lateral pelvic displacement decreased significantly with stabilization in all groups, especially in TT. Contrary to expectations, external lateral stabilization did not result in a larger decrease in the energy cost of walking for LLA compared to able-bodied controls, suggesting that balance control is not a major factor in the increased cost of walking in LLA. Alternatively, the increased energy cost with stabilization for TF suggests that restraining (medio-lateral) pelvic motion impeded necessary movement adaptations in LLA, and thus negated the postulated beneficial effects of stabilization on the energy cost of walking.
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Heliomare Research & Development, Relweg 51, 1949 EC Wijk aan Zee, The Netherlands. Electronic address: t.ijmker@vu.nl.
authors.forename: T
authors.initials: T
authors.lastname: IJmker
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Noten
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Lamoth
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Brunel University, School of Sport and Education, Kingston Lane, UB8 3PH Uxbridge, Middlesex, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Beek
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV Groningen, The Netherlands.
authors.forename: L H V
authors.initials: LH
authors.lastname: van der Woude
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Heliomare Research & Development, Relweg 51, 1949 EC Wijk aan Zee, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Houdijk
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D000674:Amputees; D016022:Case-Control Studies; D004185:Disability Evaluation; D004734:Energy Metabolism; D005080:Exercise Test; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D010101:Oxygen Consumption / Q000502:physiology; D004856:Postural Balance / Q000502:physiology*; D013977:Tibia / Q000601:surgery; D016138:Walking / Q000502:physiology*
keywords: Balance control; Energy cost; External lateral stabilization; Gait; Gait economy; Lower limb amputation