Reorganisation of Postural Control Following Lower Limb Amputation: Theoretical Considerations and Implications for Rehabilitation

Abstract

The reorganisation of standing balance after a lower limb amputation is considered, with emphasis on persons with an acquired unilateral amputation above the ankle and below the hip joint. In the first section, three major peripheral motor and sensory impairments are discussed: (a) a lack of ankle torque generation to restore equilibrium in the sagittal plane, (b) a lack of weight-shifting capacity to control posture in the frontal plane and (c) a distorted somatosensory input from the side of amputation. In the second part of die paper, it is argued that a lower limb amputation, as any other serious peripheral lesion, also affects the highest levels of the sensorimotor system, because the functional recovery after amputation requires a central adaptation to the alterations of peripheral motor and sensory conditions. A reduction in the cognitive regulation of posture as well as a decrease in visual dependency are proposed as two of the most critical parameters of the long-term central adaptation process and as relevant indicators of the restoration of (the safe performance of) gross motor skills. In the final section, some implications for the management, balance assessment and training of persons with a lower limb amputation are mentioned.