Quantifying Static and Dynamic Stability in Amputees with Low Activity

Abstract: Background: Approximately 67% of lower limb amputees fall once or more every year. It is important for their daily functioning and their social life that their prosthetic device provide them with stability and security. Measuring stability for amputees and their prosthetic devices is challenging, especially for amputees with low activity level. However, it is important for the users and the product designers to know if the products are actually providing the user with more stability. Objective: The aim of the study is to create a measurement protocol to quantify static and dynamic stability with enough sensitivity to differentiate between two prosthetic products for amputees with low activity level. Methods: Ten K2, unilateral transtibial subjects were recruited and 6 of them completed the protocol during a 2-hour visit. They repeated the same protocol for two prosthetic feet, K2C (Össur, Iceland) and K2 Sensation (Össur, Iceland). In order to compare the static and dynamic stability of the subjects and the products, three different tests and one questionnaire were used: Static standing test, Limit of Stability (LOS) test, Walking on level ground, and the Activities-specific Balance Confidence scale (ABC scale). Results: For the static standing test, the K2Sensation showed less range for the center of pressure in the anteroposterior direction while standing in a normal position with the eyes open. However, the participants were able to reach further (LOS test) over their prosthetic side while wearing the K2C foot. For the K2C foot, gait parameters such as ankle power, positive work, self selected walking speed and the range of motion in the prosthetic ankle all increased. The backward margin of stability (BwMOS) only increased for 2 participants who had it in common to both wear ProFlex-XC in daily life. No difference was seen in perceived stability according to the ABC scale. Conclusion: The aim of the study was reached. Static and dynamic stability were quantified and distinguished between the 2 different prosthetic feet. It is concluded that both the static standing test and the LOS test are necessary parts of the protocol as they capture different aspects of static stability. For future studies, a longer adaptation time is suggested for the participants to achieve a stable gait pattern and to answer the ABC scale with more reliability