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Kaufman KR, Miller EJ, Deml CM, Sheehan RC, Grabiner MD, Wyatt M, Zai CZ, Kingsbury T, Tullos ML, Acasio JC, Mahon CE, Hendershot BD, Dearth CL. Fall Prevention Training for Service Members With an Amputation or Limb Salvage Following Lower Extremity Trauma. Mil Med 2024; 189:980-987. [PMID: 36794799 DOI: 10.1093/milmed/usad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/02/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Recent military conflicts have resulted in a significant number of lower extremity injuries to U.S. service members that result in amputation or limb preservation (LP) procedures. Service members receiving these procedures report a high prevalence and deleterious consequences of falls. Very little research exists to improve balance and reduce falls, especially among young active populations such as service members with LP or limb loss. To address this research gap, we evaluated the success of a fall prevention training program for service members with lower extremity trauma by (1) measuring fall rates, (2) quantifying improvements in trunk control, and (3) determining skill retention at 3 and 6 months after training. MATERIALS AND METHODS Forty-five participants (40 males, mean [±SD] age, 34 ± 8 years) with lower extremity trauma (20 with unilateral transtibial amputation, 6 with unilateral transfemoral amputation, 5 with bilateral transtibial amputation, and 14 with unilateral LP procedures) were enrolled. A microprocessor-controlled treadmill was used to produce task-specific postural perturbations which simulated a trip. The training was conducted over a 2-week period and consisted of six 30-minute sessions. The task difficulty was increased as the participant's ability progressed. The effectiveness of the training program was assessed by collecting data before training (baseline; repeated twice), immediately after training (0 month), and at 3 and 6 months post-training. Training effectiveness was quantified by participant-reported falls in the free-living environment before and after training. Perturbation-induced recovery step trunk flexion angle and velocity was also collected. RESULTS Participants reported reduced falls and improved balance confidence in the free-living environment following the training. Repeated testing before training revealed that there were no pre-training differences in trunk control. The training program improved trunk control following training, and these skills were retained at 3 and 6 months after training. CONCLUSION This study showed that task-specific fall prevention training reduced falls across a cohort of service members with diverse types of amputations and LP procedures following lower extremity trauma. Importantly, the clinical outcome of this effort (i.e., reduced falls and improved balance confidence) can lead to increased participation in occupational, recreational, and social activities and thus improved quality of life.
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Affiliation(s)
- Kenton R Kaufman
- Mayo Clinic, Motion Analysis Laboratory, Rochester, MN 55905, USA
| | - Emily J Miller
- Mayo Clinic, Motion Analysis Laboratory, Rochester, MN 55905, USA
| | - Christine M Deml
- Mayo Clinic, Motion Analysis Laboratory, Rochester, MN 55905, USA
| | - Riley C Sheehan
- Department of Rehabilitation Medicine, Center for the Intrepid-Brooke Army Medical Center, San Antonio, TX 78219, USA
- Department of Kinesiology and Nutrition/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | | | - Marilynn Wyatt
- Naval Medical Center San Diego, Motion Analysis Laboratory, San Diego, CA 92134, USA
| | - Claire Z Zai
- Naval Medical Center San Diego, Motion Analysis Laboratory, San Diego, CA 92134, USA
| | - Trevor Kingsbury
- Naval Medical Center San Diego, Motion Analysis Laboratory, San Diego, CA 92134, USA
| | - Meghan L Tullos
- Department of Kinesiology and Nutrition/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Julian C Acasio
- Department of Kinesiology and Nutrition/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Caitlin E Mahon
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio Fort Sam Houston, TX 78234, USA
| | - Brad D Hendershot
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio Fort Sam Houston, TX 78234, USA
| | - Christopher L Dearth
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio Fort Sam Houston, TX 78234, USA
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Somaiya KJ, Samal S, Boob MA. Physiotherapeutic Intervention Techniques for Knee Osteoarthritis: A Systematic Review. Cureus 2024; 16:e56817. [PMID: 38654798 PMCID: PMC11037114 DOI: 10.7759/cureus.56817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Globally, knee osteoarthritis (KOA) is the leading cause of disability. The most prevalent complaints associated with KOA are knee pain, joint stiffness, and weakness in the muscles of the lower limbs. These symptoms impede movement and result in functional limitations. As a result, people with KOA have a lower quality of life. For all patient groups with knee OA, an effective rehabilitation program focuses on improving knee range of motion, isometric quadriceps strength, and productivity level while reducing discomfort. The American College of Rheumatology (ACR) categorization criteria for KOA, research on KOA physiotherapy, and reviews covering various physical therapy interventions, including exercise, physical modalities, and patient education, were used to narrow down the pool of 180 systematic reviews to 15 articles. Google Scholar, PubMed, the Cochrane Library, and EMBASE were the databases that were used. The following keyword combinations were included in our search: KOA and physiotherapy or interventions or exercises, strengthening and stretching, concentric and eccentric training. Through our analysis, we identified a few methods that, in addition to standard therapy, could be used in clinical settings for people with osteoarthritis in the knee. It has been shown that Mulligan, Pilates, Kinesiotaping, Aquatic Therapy, and other current therapies are effective. The study employed a broad range of results. This review concludes that rather than relying solely on conventional therapy, it is preferable to combine a number of the most current physiotherapy techniques with it.
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Affiliation(s)
- Kamya J Somaiya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kim J, Foucher K. Fall experiences from the perspectives of people with osteoarthritis: in their own words. Disabil Rehabil 2024; 46:77-85. [PMID: 36519505 DOI: 10.1080/09638288.2022.2156629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To explore real-life experiences of people with osteoarthritis (OA) to increase understanding of how they perceive contributing factors to falls, circumstances at time of falls, and consequences of falls. MATERIALS AND METHODS Four focus groups of 3-7 people with OA from the Chicago, IL, USA, and neighboring areas were conducted remotely via web-based videoconferencing. Inclusion criteria included history of falls in previous 12 months and hip and/or knee OA. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify themes. RESULTS Focus group participants (n = 17) described experiences associated with fall-related events that resulted in the identification of four themes: (1) perception of falls and fall risks can be influenced by OA symptoms, (2) ability to remember circumstances of falls are influenced by consequences, (3) behaviors and attitudes that address OA symptoms and avoidance of falls are similar and (4) OA symptoms and falls have common psychological impacts on lives. CONCLUSION Our study highlights how people with OA define falls, perceive contributing factors to falls, and describe general and OA-related factors that contributed to their fall experiences. The shared experiences contributed to the creation of themes that represented various aspects of the circumstances and impact of falls. Consideration for the identified themes may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and prioritize research into the biopsychosocial effects of falls in people with OA.IMPLICATIONS FOR REHABILITATIONInformation about circumstances of a fall such as location, activity, and symptoms of osteoarthritis may be beneficial in creating tailored fall prevention training and education.Falls are a common problem for people with lower limb osteoarthritis that can lead to negative changes in activity and quality of life.The psychological impact of osteoarthritis symptoms may be contributing to fear of falling and decrease participation in daily activities.Awareness of the perceptions people with osteoarthritis have about their symptoms may provide educational and training opportunities to address the benefits of different therapeutic treatments.Awareness of perceptions people with osteoarthritis have about their risk of falling may provide educational and training opportunities to address the benefits of different therapeutic treatments.
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Affiliation(s)
- Janis Kim
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Eveld ME, King ST, Zelik KE, Goldfarb M. Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses. J Neuroeng Rehabil 2022; 19:101. [PMID: 36151561 PMCID: PMC9502957 DOI: 10.1186/s12984-022-01070-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Transfemoral prosthesis users’ high fall rate is related to increased injury risk, medical costs, and fear of falling. Better understanding how stumble conditions (e.g., participant age, prosthesis type, side tripped, and swing phase of perturbation) affect transfemoral prosthesis users could provide insight into response deficiencies and inform fall prevention interventions. Methods Six unilateral transfemoral prosthesis users experienced obstacle perturbations to their sound limb in early, mid, and late swing phase. Fall outcome, recovery strategy, and kinematics of each response were recorded to characterize (1) recoveries versus falls for transfemoral prosthesis users and (2) prosthesis user recoveries versus healthy adult recoveries. Results Out of 26 stumbles, 15 resulted in falls with five of six transfemoral prosthesis users falling at least once. By contrast, in a previously published study of seven healthy adults comprising 214 stumbles using the same experimental apparatus, no participants fell. The two oldest prosthesis users fell after every stumble, stumbles in mid swing resulted in the most falls, and prosthesis type was not related to strategy/fall outcomes. Prosthesis users who recovered used the elevating strategy in early swing, lowering strategy in late swing, and elevating or lowering/delayed lowering with hopping in mid swing, but exhibited increased contralateral (prosthetic-side) thigh abduction and trunk flexion relative to healthy controls. Falls occurred if the tripped (sound) limb did not reach ample thigh/knee flexion to sufficiently clear the obstacle in the elevating step, or if the prosthetic limb did not facilitate a successful step response after the initial sound-side elevating or lowering step. Such responses generally led to smaller step lengths, less anterior foot positioning, and more forward trunk flexion/flexion velocity in the resulting foot-strikes. Conclusions Introducing training (e.g., muscle strength or task-specific motor skill) and/or modifying assistive devices (e.g., lower-limb prostheses or exoskeletons) may improve responses for transfemoral prosthesis users. Specifically, training or exoskeleton assistance could help facilitate sufficient thigh/knee flexion for elevating; training or prosthesis assistance could provide support-limb counteracting torques to aid in elevating; and training or prosthesis assistance could help initiate and safely complete prosthetic swing. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01070-y.
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Affiliation(s)
- Maura E Eveld
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Shane T King
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karl E Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.,Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, USA
| | - Michael Goldfarb
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.,Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, USA.,Department of Electrical Engineering, Vanderbilt University, Nashville, TN, USA
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Rutherford D, Baker M, Urquhart N, Stanish W. The effect of a frontal plane gait perturbation bout on knee biomechanics and muscle activation in older adults and individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2022; 92:105574. [PMID: 35066441 DOI: 10.1016/j.clinbiomech.2022.105574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking can be a challenging task for individuals with knee osteoarthritis and many older adults. The purpose was to determine the immediate effect of a frontal plane perturbation bout during walking on knee biomechanics and muscle activation patterns in these groups. METHODS 44 asymptomatic older adults and 32 individuals with knee osteoarthritis were recruited. Sagittal and frontal plane knee biomechanics and muscle activation levels were calculated and recorded during treadmill walking. After a baseline collection at 6-min, a random series of unexpected medial/lateral walkway surface perturbations were delivered over approximately 24 min. Data was collected immediately after the perturbations. Discrete measures extracted from biomechanical waveforms, and principal component analysis to analyze muscle activation were utilized to determine time effects and interactions using analysis of variance models (alpha = 0.05). FINDINGS After the perturbation bout, sagittal plane range of motion was significantly increased in the osteoarthritis group (Effect Size = 0.24) and in both groups peak knee adduction moment (Effect Size = 0.10) and difference between peak flexion and extension moments (Effect Size = 0.16) were significantly increased. Muscle amplitudes in both groups were significantly reduced (PP1-scores) after perturbation bout, whereas significant time-based gait cycle activation pattern alterations identified by PP2- and PP3-scores were related to group and muscle assignment. INTERPRETATION Perturbations were tolerated by all participants, resulting in significant alterations to biomechanical outcomes and muscle activation levels and patterns. Demand on the knee joint was not increased after perturbations. Gait perturbation training in these groups may be feasible using a frontal plane perturbation bout.
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Affiliation(s)
- Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
| | - Matthew Baker
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Nathan Urquhart
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - William Stanish
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
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Grabiner MD, Kaufman KR. Developing and Establishing Biomechanical Variables as Risk Biomarkers for Preventable Gait-Related Falls and Assessment of Intervention Effectiveness. Front Sports Act Living 2021; 3:722363. [PMID: 34632378 PMCID: PMC8492908 DOI: 10.3389/fspor.2021.722363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023] Open
Abstract
The purpose of this review is to position the emerging clinical promise of validating and implementing biomechanical biomarkers of falls in fall prevention interventions. The review is framed in the desirability of blunting the effects of the rapidly growing population of older adults with regard to the number of falls, their related injuries, and health care costs. We propose that biomechanical risk biomarkers may be derived from systematic study of the responses to treadmill-delivered perturbations to both identify individuals with a risk of specific types of falls, such as trips and slips as well as quantifying the effectiveness of interventions designed to reduce that risk. The review follows the evidence derived using a specific public health approach and the published biomedical literature that supports trunk kinematics as a biomarker as having met many of the criteria for a biomarker for trip-specific falls. Whereas, the efficacy of perturbation training to reduce slip-related falls by older adults appears to have been confirmed, its effectiveness presently remains an open and important question. There is a dearth of data related to the efficacy and effectiveness of perturbation training to reduce falls to the side falls by older adults. At present, efforts to characterize the extent to which perturbation training can reduce falls and translate the approaches to the clinic represents an important research opportunity.
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Affiliation(s)
- Mark D Grabiner
- Biomechanics and Clinical Biomechanics Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - K R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
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