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    Comparative Analysis of Standing Postural Control and Perturbation-Induced Muscle Activity in Transtibial and Transfemoral Amputees
    (MDPI, 2025) Türkmen, MC; Çelik, H; Yalçın, Aİ; Topuz, S
    Background/Objective: Postural control differs between individuals with lower limb amputation and the general population. Although previous studies examined the effects of unexpected surface perturbations on postural control in individuals with transtibial amputation (TTA) and individuals with transfemoral amputation (TFA), their impact on lower limb muscle activation remains unclear. This study aimed to assess postural control on a stable surface and to evaluate the effects of unexpected surface perturbations on lower limb muscle activation in unilateral TTAs, TFAs, and in a healthy control group (CG). Methods: The study included 10 TTAs, 9 TFAs, and 10 healthy controls. Postural control was assessed using a force platform, and lower limb muscle activity was recorded with surface electromyography during unexpected surface perturbations. Results: The TFAs showed the highest anteroposterior and lateral postural sway under compliant surface eyes closed and the highest lateral sway under normal surface eyes closed, whereas the CG showed the lowest values (p < 0.05). During forward perturbations, rectus femoris (RF) and tibialis anterior (TA) activations were significantly higher than biceps femoris (BF) and medial head of the gastrocnemius (GM) activations, respectively, across all groups (p < 0.05). During backward perturbations, GM activations exceeded TA activations in all groups, while BF activations were higher than RF only in TTAs (p < 0.05). Significant group effects were found for RF and BF during forward perturbations, and side effects for BF (forward) and RF (backward) activations (p < 0.05). Conclusions: Postural control responses vary with the level of lower limb amputation. TFAs relied more on visual input during quiet standing, whereas TTAs demonstrated greater reliance on thigh muscle activation during surface perturbations. These findings highlight the need to consider amputation level in balance and rehabilitation programs.
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    Öğe
    Postural control and trunk muscle activation in transtibial amputees: A pilot electromyographic study
    (PUBLIC LIBRARY SCIENCE, 2025) Çelik, H; Türkmen, MC; Yalçın, Aİ; Topuz, S
    Transtibial amputation affects postural stability, requiring trunk muscle analysis to support balance and rehabilitation. This pilot study aimed to compare trunk muscle activations during postural sway and limits of stability in unilateral transtibial amputees with healthy controls and investigate the relationship between postural control and trunk muscle activations in transtibial amputees. Accordingly, it was hypothesised that transtibial amputees would exhibit altered postural control and trunk muscle activation, both compared to controls and between limbs. This preliminary observational cross-sectional study included a transtibial amputee group (n = 10) and a healthy control group (n = 10). Static and dynamic balance were assessed using a Bertec force platform. Trunk muscle activation was measured bilaterally using the Delsys wireless surface electromyography system while balance was assessed. Subsequently, group differences in postural control and trunk muscle activation were analyzed. Transtibial amputee group showed significantly greater limits of stability distance on the amputated side compared to controls' non-dominant side (p < 0.05). Additionally, transtibial amputee group exhibited greater lateral postural sway under compliant surface conditions compared to healthy controls (p < 0.05). During limits of stability assesment, external oblique activation was higher on the intact side of transtibial amputee group compared to controls' dominant side and higher than on the amputated side (p < 0.05). Multifidus activation on the amputated side during compliant surface with eyes open was greater than the intact side (p < 0.05). Longissimus dorsi activation on the intact side in amputee group exceeded controls' dominant side under all conditions (p < 0.05). Moreover, longissimus dorsi activation on the amputated side was significantly higher than on the controls' nondominant side during compliant surface with eyes closed (p < 0.05). Preliminary findings highlight disrupted postural control and trunk muscle activation in transtibial amputees, indicating the need for targeted rehabilitation and larger studies.