Vol.:(0123456789) 1 3
Experimental Brain Research
https://doi.org/10.1007/s00221-018-5419-8
RESEARCH ARTICLE
Biomechanical and neurocognitive performance outcomes of walking
with transtibial limb loss while challenged by a concurrent task
Alison L. Pruziner
1,2,3
· Emma P. Shaw
2,4,5
· Jeremy C. Rietschel
4,6
· Brad D. Hendershot
1,2,3
· Matthew W. Miller
7
·
Erik J. Wolf
1,2,3
· Bradley D. Hatfeld
4,5
· Christopher L. Dearth
1,2,3,8
· Rodolphe J. Gentili
4,5,9
Received: 19 March 2018 / Accepted: 26 October 2018
© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign
copyright protection 2018
Abstract
Individuals who have sustained loss of a lower limb may require adaptations in sensorimotor and control systems to efectively
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 difculty (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 specifc diferences were also observed. These fndings confrm
and extend prior eforts indicating that dual-task walking can negatively afect 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.
Keywords Limb loss · Cognitive workload · Biomechanics · Electroencephalogram · Dual-task walking
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 Adminis-
tration-Task Load Index
TT Transtibial limb loss
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00221-018-5419-8) contains
supplementary material, which is available to authorized users.
* Alison L. Pruziner
alison.l.pruziner.civ@mail.mil
1
DoD-VA Extremity Trauma and Amputation Center
of Excellence, Bethesda, MD, USA
2
Department of Rehabilitation, Walter Reed National Military
Medical Center, Bethesda, MD, USA
3
Department of Rehabilitation Medicine, Uniformed Services
University of the Health Sciences, Bethesda, MD, USA
4
Department of Kinesiology, School of Public Health,
University of Maryland, College Park, MD, USA
5
Neuroscience and Cognitive Science Program, University
of Maryland, College Park, MD, USA
6
Baltimore Veterans Administration Medical Center,
Baltimore, MD, USA
7
Center for Neuroscience, School of Kinesiology, Auburn
University, Auburn, AL, USA
8
Department of Surgery, Uniformed Services University
of the Health Sciences, Bethesda, MD, USA
9
Maryland Robotics Center, University of Maryland,
College Park, MD, USA