ANTICIPATORY POSTURAL ADJUSTMENTS DURING STANDING IN BELOW-THE-KNEE AMPUTEES

Objective. We studied the role of adaptive changes within the central nervous system in anticipatory postural adjustments seen in unilateral below-the-knee amputees. Design. Changes in electromyographic and mec hanical variables were compared during standardized tasks performed by standing subjects. Background. Anticipatory postural adjustments repr esent an important mechanism of postural control which was expected to be changed in amputees because of both mechanical and secondary, neur ological reasons. Methods. Six patients after a below-the-knee amputat ion and six control subjects stood on a force platform and performed f ast bilateral shoulder movements and also dropped or caught a load fro m (into) extended hands. Anticipatory changes in the background activi ty of postural muscles were analysed. Results. In amputees, there were cases of marked asymmetry in anticipatory changes of the background m uscle activity which were larger on the intact side of the body but we re commonly small or absent on the side of the amputation. This asymme try could lead to larger mediolateral forces and displacements of the centre of pressure. Conclusions. We suggest that asymmetrical patterns of anticipatory postural adjustments reflect central adaptive changes secondary to the amputation. Rehabilitation approaches would benefit from understanding and taking advantage of the adaptive changes within the central nervous system.