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      Locomotor adaptability in persons with unilateral transtibial amputation

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          Abstract

          Background

          Locomotor adaptation enables walkers to modify strategies when faced with challenging walking conditions. While a variety of neurological injuries can impair locomotor adaptability, the effect of a lower extremity amputation on adaptability is poorly understood.

          Objective

          Determine if locomotor adaptability is impaired in persons with unilateral transtibial amputation (TTA).

          Methods

          The locomotor adaptability of 10 persons with a TTA and 8 persons without an amputation was tested while walking on a split-belt treadmill with the parallel belts running at the same (tied) or different (split) speeds. In the split condition, participants walked for 15 minutes with the respective belts moving at 0.5 m/s and 1.5 m/s. Temporal spatial symmetry measures were used to evaluate reactive accommodations to the perturbation, and the adaptive/de-adaptive response.

          Results

          Persons with TTA and the reference group of persons without amputation both demonstrated highly symmetric walking at baseline. During the split adaptation and tied post-adaptation walking both groups responded with the expected reactive accommodations. Likewise, adaptive and de-adaptive responses were observed. The magnitude and rate of change in the adaptive and de-adaptive responses were similar for persons with TTA and those without an amputation. Furthermore, adaptability was no different based on belt assignment for the prosthetic limb during split adaptation walking.

          Conclusions

          Reactive changes and locomotor adaptation in response to a challenging and novel walking condition were similar in persons with TTA to those without an amputation. Results suggest persons with TTA have the capacity to modify locomotor strategies to meet the demands of most walking conditions despite challenges imposed by an amputation and use of a prosthetic limb.

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          Most cited references35

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          Interlimb coordination during locomotion: what can be adapted and stored?

          Interlimb coordination is critically important during bipedal locomotion and often must be adapted to account for varying environmental circumstances. Here we studied adaptation of human interlimb coordination using a split-belt treadmill, where the legs can be made to move at different speeds. Human adults, infants, and spinal cats can alter walking patterns on a split-belt treadmill by prolonging stance and shortening swing on the slower limb and vice versa on the faster limb. It is not known whether other locomotor parameters change or if there is a capacity for storage of a new motor pattern after training. We asked whether adults adapt both intra- and interlimb gait parameters during split-belt walking and show aftereffects from training. Healthy subjects were tested walking with belts tied (baseline), then belts split (adaptation), and again tied (postadaptation). Walking parameters that directly relate to the interlimb relationship changed slowly during adaptation and showed robust aftereffects during postadaptation. These changes paralleled subjective impressions of limping versus no limping. In contrast, parameters calculated from an individual leg changed rapidly to accommodate split-belts and showed no aftereffects. These results suggest some independence of neural control of intra- versus interlimb parameters during walking. They also show that the adult nervous system can adapt and store new interlimb patterns after short bouts of training. The differences in intra- versus interlimb control may be related to the varying complexity of the parameters, task demands, and/or the level of neural control necessary for their adaptation.
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            Central pattern generators for locomotion, with special reference to vertebrates.

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              Proprioception and locomotor disorders.

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 July 2017
                2017
                : 12
                : 7
                : e0181120
                Affiliations
                [1 ] Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, United States of America
                [2 ] Department of Research, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia, United States of America
                [3 ] Kennedy Krieger Institute, Baltimore, Maryland, United States of America
                [4 ] Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
                [5 ] Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
                [6 ] DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), Bethesda, Maryland, United States of America
                [7 ] BADER Consortium, University of Delaware, Newark, Delaware, United States of America
                [8 ] Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
                University of Colorado Boulder, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3490-8562
                Article
                PONE-D-17-13462
                10.1371/journal.pone.0181120
                5507533
                28704467
                997c2af9-c7d9-4879-a5e6-ecc6e0d88feb

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 6 April 2017
                : 26 June 2017
                Page count
                Figures: 7, Tables: 1, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: KL2TR000057
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000090, Congressionally Directed Medical Research Programs;
                Award ID: W81XWH-11-2-0222
                Award Recipient :
                Funded by: Department of Defense-Veteran Affairs
                Award ID: Extremity Trauma and Amputation Center of Excellence (Public Law 110-417, National Defense Authorization Act 2009, Section 723)
                Award Recipient :
                Support for this project was provided, in part, by Clinical and Translational Science Awards (CTSA) No. KL2TR000057 from the National Center for Advancing Translational Sciences, the BADER Consortium via the Congressionally Designated Medical Research Program (Award number W81XWH-11-2-0222), and the DoD-VA Extremity Trauma and Amputation Center of Excellence (Public Law 110-417, National Defense Authorization Act 2009, Section 723). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Walking
                Biology and Life Sciences
                Biotechnology
                Medical Devices and Equipment
                Assistive Technologies
                Prosthetics
                Medicine and Health Sciences
                Medical Devices and Equipment
                Assistive Technologies
                Prosthetics
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Legs
                Ankles
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Legs
                Ankles
                Physical Sciences
                Materials Science
                Materials by Structure
                Fibers
                Carbon Fiber
                Physical Sciences
                Materials Science
                Material Properties
                Mechanical Properties
                Stiffness
                Medicine and Health Sciences
                Health Care
                Physiotherapy
                Engineering and Technology
                Control Engineering
                Control Systems
                Computer and Information Sciences
                Systems Science
                Control Systems
                Physical Sciences
                Mathematics
                Systems Science
                Control Systems
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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