Perturbation recovery during walking is impacted by knowledge of perturbation timing in below-knee prosthesis users and non-impaired participants

Previous research found that below-knee prosthesis users proactively increase their lateral margin-of-stability on their impaired side in anticipation of an impending perturbation when the timing is predictable and potentially directed toward the impaired limb. While knowledge of perturbation timing and direction influences proactive strategies, the consequences of such knowledge and anticipatory behavior on recovery from perturbations is unclear. This study characterized center-of-mass (CoM) dynamics of below-knee prosthesis users and non-impaired controls following a lateral perturbation when the perturbation direction is known but a priori knowledge of the timing of perturbation is either known or unknown. Across groups, CoM displacement during perturbation exposure increased when directed towards the impaired or non-dominant limb with no influence of timing knowledge. In addition, peak CoM displacement was less with known timing irrespective of the perturbation direction. Generally, the CoM displacement during perturbation exposure correlated well with the CoM medial-lateral velocity during unperturbed walking, supporting evidence that human response dynamics to lateral perturbations are influenced by the instantaneous state of the body's momentum.

Proactive Locomotor Adjustments Are Specific to Perturbation Uncertainty in Below-Knee Prosthesis Users

Sensory-motor deficits associated with below-knee amputation impair reactions to external perturbations. As such, below-knee prosthesis users rely on proactive control strategies to maintain locomotor stability. However, there are trade-offs (metabolic, comfort, etc.) associated with proactive strategies. We hypothesize that because proactive control strategies are costly, prosthesis users and non-impaired participants will use a priori knowledge (timing, direction) of an impending lateral perturbation to make specific gait adaptations only when the timing of the perturbation is known and the adaptation can be temporally-limited. This hypothesis was partially supported. When the perturbation timing was predictable, only prosthesis users, and only on their impaired side, increased their lateral margin of stability during the steps immediately preceding the perturbation when perturbation direction was either unknown or known to be directed towards their impaired side. This strategy should reduce the likelihood of requiring a corrective step to maintain stability. However, neither group exhibited substantial proactive adaptations compared to baseline walking when perturbation timing was unpredictable, independent of perturbation direction knowledge. The absence of further proactive stabilization behaviors observed in prosthesis users in anticipation of a certain but temporally unpredictable perturbation may be partially responsible for impaired balance control.