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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Article info
Publication history
Published online: January 19, 2022
Accepted:
January 13,
2022
Received:
October 25,
2021
Identification
Copyright
Published by Elsevier Ltd.
