Highlights
- •Low back pain alters trunk-lower limb coordination in persons with lower limb loss.
- •Trunk-hip coordination predicts center of mass variability during standing balance.
- •Opposing trunk-hip coordination may illustrate a mechanism for back pain recurrence.
Abstract
Background
Balance is sustained through multi-joint coordination in response to postural perturbations.
Low back pain alters postural responses; however, it is unknown how coordination between
the trunk and lower extremities affects center of mass control during standing balance
among persons with limb loss, particularly those with back pain.
Methods
Forty participants with unilateral lower limb loss (23 with back pain) stood with
eyes open and closed on a firm surface, while wearing IMUs on the sternum, pelvis,
and bilaterally on the thigh, shank, and foot. A state-space model with Kalman filter
calculated sagittal trunk, hip, knee, and ankle joint angles. Fuzzy entropy quantified
center of mass variability of sagittal angular velocity at the sacrum. Normalized
cross-correlation functions identified coordination patterns (trunk-hip, trunk-knee,
trunk-ankle). Multiple linear regression predicted fuzzy entropy from cross-correlation
values for each pattern, with body mass and amputation level as covariates.
Findings
With eyes open, trunk-lower limb joint coordination on either limb did not predict
fuzzy entropy. With eyes closed, positive trunk-hip coordination on the intact limb
predicted fuzzy entropy in the pain group (p = 0.02), but not the no pain group. On the prosthetic side, inverse trunk-hip coordination
patterns predicted fuzzy entropy in pain group (p = 0.03) only.
Interpretation
Persons with limb loss and back pain demonstrated opposing coordination strategies
between the lower limbs and trunk when vision was removed, perhaps identifying a mechanism
for pain recurrence. Vision is the dominant source of balance stabilization in this
population, which may increase fall risk when visual feedback is compromised.
Keywords
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References
- Feedback equilibrium control during human standing.Biol. Cybern. 2005; 93: 309-322
- A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass.Curr. Opin. Neurol. 2005; 18: 15-21
- Impact of traumatic lower extremity injuries beyond acute care: movement-based considerations for resultant longer term secondary health conditions.Adv. Wound Care. 2017; 6: 269-278
- Trunk muscle activation patterns during walking among persons with lower limb loss: influences of walking speed.J. Electromyogr. Kinesiol. 2018; 40: 48-55
- Joint power distribution does not change within the contralateral limb one year after unilateral limb loss.Gait Posture. 2019; 73: 8-13
- Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss.Gait Posture. 2019; 74: 236-241
- Lower limb joint-specific contributions to standing postural sway in persons with unilateral lower limb loss.Gait Posture. 2021; 89: 109-114
- Movement variability emerges in gait as adaptation to task constraints in dynamic environments.Gait Posture. 2019; 70: 1-5
- Characterization of surface EMG signal based on fuzzy entropy.IEEE Trans. Neural Syst. Rehab. Eng. 2007; 15: 266-272
- Asymmetrical movements of the lumbopelvic region: is this a potential mechanism for low back pain in people with lower limb amputation?.Med. Hypotheses. 2014; 82: 77-85
- Body sway and vision.J. Exp. Psychol. Hum. Percept. Perform. 1946; 36: 699-703
- Back pain as a secondary disability in persons with lower limb amputations.Arch. Phys. Med. Rehabil. 2001; 82: 731-734
- Humans integrate visual and haptic information in a statistically optimal fashion.Nature. 2002; 415: 429-433
- Standing on slopes–how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task.J. Neuroeng. Rehabil. 2017; 14: 1-16
- Biopsychosocial risk factors associated with chronic low back pain after lower limb amputation.Med. Hypotheses. 2017; 108: 1-9
- Joint coordination in young and older adults during quiet stance: effect of visual feedback of the center of pressure.Gait Posture. 2012; 35: 83-87
- Three-dimensional motions of trunk and pelvis during transfemoral amputee gait.Arch. Phys. Med. Rehabil. 2008; 89: 87-94
- All leg joints contribute to quiet human stance: a mechanical analysis.J. Biomech. 2009; 42: 2739-2746
- Phase synchronisation of the three leg joints in quiet human stance.Gait Posture. 2011; 33: 412-417
- Signal-dependent noise determines motor planning.Nature. 1998; 394: 780-784
- Validation of magneto-inertial measuring units for measuring hip joint angles.J. Biomech. 2019; 91: 170-174
- Control and estimation of posture during quiet stance depends on multijoint coordination.J. Neurophysiol. 2007; 97: 3024-3035
- Joint coordination during quiet stance: effects of vision.Exp. Brain Res. 2005; 164: 1-17
- Balance control in lower extremity amputees during quiet standing: a systematic review.Gait Posture. 2014; 39: 672-682
- The functions of vision.in: Modes of Perceiving and Processing Information. 1978 (159170)
- Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue.Hum. Mov. Sci. 2006; 25: 788-799
- Changes in trunk and pelvis motion among persons with unilateral lower limb loss during the first year of ambulation.Arch. Phys. Med. Rehabil. 2020; 101: 426-433
- Gender-specific effect of obesity on balance.Obesity. 2009; 17: 1951-1956
- Hip strategy for balance control in quiet standing is reduced in people with low back pain.Spine. 2004; 29: E107-E112
- Assessment of the measurement accuracy of inertial sensors during different tasks of daily living.J. Biomech. 2019; 84: 81-86
- Application of autocorrelation and cross-correlation analyses in human movement and rehabilitation research.J. Orthop. Sports Phys. Ther. 2009; 39: 287-295
- Kinematic gait asymmetry assessment using joint angle data in patients with chronic stroke—a normalized cross-correlation approach.Gait Posture. 2020; 80: 168-173
- Joint kinematics estimate using wearable inertial and magnetic sensing modules.Gait Posture. 2008; 28: 588-595
- Peak sagittal plane spine kinematics in female gymnasts with and without a history of low back pain.Clin. Biomech. 2020; 76105019
- Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain.Spine. 2001; 26: 724-730
- Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature.Eur. Spine J. 2011; 20: 358-368
- The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations.Gait Posture. 2014; 40: 640-646
- Role of visual input in nonlinear postural control system.Exp. Brain Res. 2002; 147: 1-7
- Non-linear stimulus-response behavior of the human stance control system is predicted by optimization of a system with sensory and motor noise.J. Comput. Neurosci. 2011; 30: 759-778
- Behavioral effect of knee joint motion on body's center of mass during human quiet standing.Gait Posture. 2015; 41: 291-294
Article info
Publication history
Published online: January 19, 2022
Accepted:
January 13,
2022
Received:
October 25,
2021
Identification
Copyright
Published by Elsevier Ltd.