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Biomechanical and neurocognitive performance outcomes of walking with transtibial limb loss while challenged by a concurrent task

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Abstract

Individuals who have sustained loss of a lower limb may require adaptations in sensorimotor and control systems to effectively utilize a prosthesis, and the interaction of these systems during walking is not clearly understood for this patient population. The aim of this study was to concurrently evaluate temporospatial gait mechanics and cortical dynamics in a population with and without unilateral transtibial limb loss (TT). Utilizing motion capture and electroencephalography, these outcomes were simultaneously collected while participants with and without TT completed a concurrent task of varying difficulty (low- and high-demand) while seated and walking. All participants demonstrated a wider base of support and more stable gait pattern when walking and completing the high-demand concurrent task. The cortical dynamics were similarly modulated by the task demand for both groups, to include a decrease in the novelty-P3 component and increase in the frontal theta/parietal alpha ratio power when completing the high-demand task, although specific differences were also observed. These findings confirm and extend prior efforts indicating that dual-task walking can negatively affect walking mechanics and/or neurocognitive performance. However, there may be limited additional cognitive and/or biomechanical impact of utilizing a prosthesis in a stable, protected environment in TT who have acclimated to ambulating with a prosthesis. These results highlight the need for future work to evaluate interactions between these cognitive–motor control systems for individuals with more proximal levels of lower limb loss, and in more challenging (ecologically valid) environments.

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Notes

  1. Auditory and not visual probes were employed since with the latter it is difficult to ascertain whether attenuations in probe-evoked brain responses are due to reductions in attentional reserve or simply failures of participants to be looking at the probes. The various shapes/colors displayed on the screen and auditory probes were simultaneously presented during the whole dual task. The frequency of presentation of the visual stimuli and auditory probes differed (objects appeared for 500 ms at a time with a random 100–1000 ms inter-stimulus interval; auditory probes were played randomly with an inter-stimulus interval of 6–30 s).

Abbreviations

ANOVA:

Analysis of variance

CAREN:

Computer-Assisted Rehabilitation ENvironment

EEG:

Electroencephalography

ERPs:

Event-related potentials

FT/PA:

Frontal theta/parietal alpha ratio

NASA-TLX:

National Aeronautics and Space Administration-Task Load Index

TT:

Transtibial limb loss

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Acknowledgements

The authors wish to thank Ms. Vanessa Gatmaitan, MS and Ms. Elizabeth Husson, BA, at Walter Reed National Military Medical Center, and Drs. Kyle Jaquess, Ph.D. and Li-Chuan Lo, Ph.D., at the University of Maryland, for their assistance with data collection and processing. This work was supported by the Center for Rehabilitation Science Research, Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, (awards HU0001-11-1-0004 and HU0001-15-2-0003) and supported by the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., and the DoD-VA Extremity Trauma and Amputation Center of Excellence (Public Law 110-417, National Defense Authorization Act 2009, Section 723). Pruziner and Wolf contributed to overall study design, data collection and interpretation, and manuscript development; Gentili, Hatfield, Miller, and Rietschel contributed to overall study design, data interpretation, and manuscript development; Hendershot and Shaw contributed to data collection and interpretation, and manuscript development; Dearth contributed to data interpretation and manuscript development.

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Authors and Affiliations

  1. DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA

    Alison L. Pruziner, Brad D. Hendershot, Erik J. Wolf & Christopher L. Dearth

  2. Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Alison L. Pruziner, Emma P. Shaw, Brad D. Hendershot, Erik J. Wolf & Christopher L. Dearth

  3. Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Alison L. Pruziner, Brad D. Hendershot, Erik J. Wolf & Christopher L. Dearth

  4. Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, USA

    Emma P. Shaw, Jeremy C. Rietschel, Bradley D. Hatfield & Rodolphe J. Gentili

  5. Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA

    Emma P. Shaw, Bradley D. Hatfield & Rodolphe J. Gentili

  6. Baltimore Veterans Administration Medical Center, Baltimore, MD, USA

    Jeremy C. Rietschel

  7. Center for Neuroscience, School of Kinesiology, Auburn University, Auburn, AL, USA

    Matthew W. Miller

  8. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Christopher L. Dearth

  9. Maryland Robotics Center, University of Maryland, College Park, MD, USA

    Rodolphe J. Gentili

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  1. Alison L. Pruziner
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  2. Emma P. Shaw
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Correspondence to Alison L. Pruziner.

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The authors declare no competing financial interests. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. The identification of specific products or instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency.

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Pruziner, A.L., Shaw, E.P., Rietschel, J.C. et al. Biomechanical and neurocognitive performance outcomes of walking with transtibial limb loss while challenged by a concurrent task. Exp Brain Res 237, 477–491 (2019). https://doi.org/10.1007/s00221-018-5419-8

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