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Am J Phys Med Rehabil. 2013 Dec;92(12):1110-8. doi: 10.1097/PHM.0b013e31829b4b7a.

Influential factors in stability of lower-limb amputees.

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From the Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran (MK, MTK); Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia (AE); and IUM University of Technology, Johor Bahru, Malaysia (HO).



Lower-limb amputation is mainly a result of trauma, vascular disease, diabetes, or congenital disorders. Persons with amputation lose their ability to stand and walk on the basis of the level of amputation. Contribution of level of amputation, type of amputation, or cause of amputation to balance impairment has not been clearly defined. Furthermore, it is controversial how much the mentioned parameters influence standing stability. Therefore, the aim of this review article was to find the relationship between the abovementioned factors and balance impairment in the available literature. It was also aimed to find the possibility of improving standing stability by the use of different prosthesis components.


An electronic search was done via the PubMed, EMBASE, and ISI Web of Knowledge databases from 1960 to 2012. Quality of the articles was assessed using the Downs and Black tool.


On the basis of the used key words, 100 articles were found, of which 20 articles were selected in accordance with the selection criteria. The scores of reporting, external validity, internal validity (bias), and internal validity (confounding) varied between 4-9, 1-3, 3-5, and 2-6, respectively.


The literature review confirmed that standing stability of amputees depends on level of amputation, type of amputation, and cause of amputation. Moreover, prosthetic characteristics such as prosthetic ankle stiffness have influences on dynamic stability, whereas torsional adaptor does not have any positive influence on stability during level walking and on turning stability. Therefore, it can be concluded that the stability of a person with amputation can be improved by the use of appropriate prosthesis components.

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