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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Lathouwers E, Díaz MA, Maricot A, Tassignon B, Cherelle C, Cherelle P, Meeusen R, De Pauw K. Therapeutic benefits of lower limb prostheses: a systematic review. J Neuroeng Rehabil 2023; 20:4. [PMID: 36639655 PMCID: PMC9840272 DOI: 10.1186/s12984-023-01128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life. OBJECTIVE To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation. METHODS We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189. RESULTS We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias. CONCLUSION Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.
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Affiliation(s)
- Elke Lathouwers
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Alejandra Díaz
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Alexandre Maricot
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Bruno Tassignon
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | | | - Romain Meeusen
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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Krauskopf T, Lauck T, Meyer B, Klein L, Mueller M, Kubosch J, Herget G, von Tscharner V, Ernst J, Stieglitz T, Pasluosta C. Neuromuscular adaptations after osseointegration of a bone-anchored prosthesis in a unilateral transfemoral amputee - a case study. Ann Med 2023; 55:2255206. [PMID: 37677026 PMCID: PMC10486294 DOI: 10.1080/07853890.2023.2255206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Many individuals with a lower limb amputation experience problems with the fitting of the socket of their prosthesis, leading to dissatisfaction or device rejection. Osseointegration (OI)- the implantation of a shaft directly interfacing with the remaining bone- is an alternative for these patients. In this observational study, we investigated how bone anchoring influences neuromuscular parameters during balance control in a patient with a unilateral transfemoral amputation. MATERIAL AND METHODS Center of pressure (CoP) and electromyography (EMG) signals from muscles controlling the hip and the ankle of the intact leg were recorded during quiet standing six months before and one and a half years after this patient underwent an OI surgery. Results were compared to a control group of nine able-bodied individuals. RESULTS Muscle co-activation and EMG intensity decreased after bone anchoring, approaching the levels of able-bodied individuals. Muscle co-activation controlling the ankle decreased in the high-frequency range, and the EMG intensity spectrum decreased in the lower-frequency range for all muscles when vision was allowed. With eyes closed, the ankle extensor muscle showed an increased EMG intensity in the high-frequency range post-surgery. CoP length increased in the mediolateral direction of the amputated leg. CONCLUSIONS These findings point to shifts in the patient's neuromuscular profile towards the one of able-bodied individuals.
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Affiliation(s)
- Thomas Krauskopf
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
| | - Torben Lauck
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Britta Meyer
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Lukas Klein
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Johanna Kubosch
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Georg Herget
- Department of Orthopaedics and Trauma Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Jennifer Ernst
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Freiburg, Germany
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Galindo Leon SA, Hassan M, Suzuki K. A Passive Three Degree of Freedom Transtibial Prosthesis With Adjustable Coronal Compliance and Independent Toe Joint. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4330-4333. [PMID: 36086623 DOI: 10.1109/embc48229.2022.9871467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The effects of including lateral compliance or a toe joint in transtibial prostheses have been studied independently, showing the potential to improve the gait biomechanics in terms of stability, walking speed, and metabolic cost. However, both of these features are not commonly found in commercial prostheses despite their importance in human gait. In this work, we present a multi-axis passive transtibial prosthesis with three degrees of freedom (DOF). The prosthesis includes a compliant and adjustable coronal articulation using beam springs, an independent 3D-printed flexible forefoot as a toe joint, and sagittal dorsiflexion-plantarflexion stiffness using a helicoidal spring. We mechanically characterize each degree of freedom in terms of the provided stiffness. The measured stiffness values were 3.26Nm/deg, 4.94, or 5.63 Nm/deg in the sagittal plane (with different springs), and 2.54 Nm/deg, 2.79 Nm/deg, 2.94 Nm/deg, or 3.72 Nm/deg in the coronal plane (by adjusting the mechanism). Finally, the effect of different types of infill and infill levels for the 3D printed toes were explored, showing stiffness varying from 2.05 N/mm to 350 N/mm. The obtained sagittal stiffness is beneath the ones found in able-bodied persons; in contrast, the lateral stiffness values are comparatively higher than that of the able-bodied persons. However, the current design is simple to rearrange and modify the stiffness values. Lastly, the wide range of stiffness achievable in the 3D printed toes can be useful to achieve proper torque requirements in the forefoot for a broad range of users.
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Influence of insole material density in the stability of patients with prosthetic unilateral transtibial amputation. Sci Rep 2022; 12:7854. [PMID: 35552421 PMCID: PMC9098549 DOI: 10.1038/s41598-022-11564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
People with lower limb amputation present greater displacements of their centre of gravity in a static situation than able-bodied individuals, as they depend on visual information to a greater extent, which implies an altered stability pattern. The efficacy of different hardness of plantar support to help maintain stability has not yet been determined. The aim of the present study is to assess stability in people with unilateral transtibial amputation with prosthesis in a static situation with insoles of different degrees of hardness and visual conditions with respect to the able-bodied population. For this purpose, 25 patients with amputation and 25 able-bodied individuals were included in both groups, postural stability was assessed by stabilometry. This assessment was carried out under normal conditions (on the floor of the dynamometric platform with eyes open), and under altered conditions (with the interposition of different materials such as plantar support: rigid and soft insoles and, eyes shut). Three variables were considered to assess stability: length of movement of the barycenter (mm), lateral velocity (mm/sg) and anterior velocity (mm/sg). All of them were analysed with the patient in static on the dynamometric platform. The results showed statistically significant differences between the two groups, (amputees and controls) with less stability in the amputee group (p < 0.05) when analysing the variables of length of movement of the barycenter, lateral velocity and anterior velocity. Amputee patients with open eyes exhibited greater stability than those with closed eyes. The hard insoles improved the stability data in amputees (length of movement of the barycenter and anterior velocity) with respect to the barefoot condition, and the soft insoles showed less stability than the patients with hard insoles, or than the barefoot patients. From the results obtained in this study, we can conclude that the PP-DWST 4 mm rigid insoles improve static stability in people with amputation. However, soft insoles impair stability and are therefore discouraged.
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Krauskopf T, Lauck TB, Klein L, Beusterien ML, Mueller M, Von Tscharner V, Mehring C, Herget GW, Stieglitz T, Pasluosta C. Unilateral transfemoral amputees exhibit altered strength and dynamics of muscular co-activation modulated by visual feedback. J Neural Eng 2022; 19. [PMID: 35100571 DOI: 10.1088/1741-2552/ac5091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Somatosensory perception is disrupted in patients with a lower limb amputation. This increases the difficulty to maintain balance and leads to the development of neuromuscular adjustments. We investigated how these adjustments are reflected in the co-activation of lower body muscles and are modulated by visual feedback. APPROACH We measured electromyography (EMG) signals of muscles from the trunk (erector spinae and obliquus external), and the lower intact/dominant leg (tibialis anterior and medial gastrocnemius) in eleven unilateral transfemoral amputees and eleven age-matched able-bodied controls during 30 seconds of upright standing with and without visual feedback. Muscle synergies involved in balance control were investigated using wavelet coherence analysis. We focused on 7 frequencies grouped in three frequency bands, a low-frequency band (7.56 and 19.86 Hz) representing more sub-cortical and spinal inputs to the muscles, a mid-frequency band (38.26 and 62.63 Hz) representing more cortical inputs, and a high-frequency band (92.90, 129 and 170.90 Hz) associated with synchronizing motor unit action potentials. Further, the dynamics of changes in intermuscular coupling over time were quantified using the Entropic Half-Life. MAIN RESULTS Amputees exhibited lower coherency values when vision was removed at 7.56 Hz for the muscle pair of the lower leg. At this frequency, the coherency values of the amputee group also differed from controls for the eyes closed condition. Controls and amputees exhibited opposite coherent behaviors with visual feedback at 7.56 Hz. For the eyes open condition at 129 Hz, the coherency values of amputees and controls differed for the muscle pair of the trunk, and at 170.90 Hz for the muscle pair of the lower leg. Amputees exhibited different dynamics of muscle co-activation at the low frequency band when vision was available. SIGNIFICANCE Altogether, these findings point to the development of neuromuscular adaptations reflected in the strength and dynamics of muscular co-activation.
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Affiliation(s)
- Thomas Krauskopf
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Torben B Lauck
- Laboratory for Biomedical Microtechnology, Department of Microsystem Engineering (IMTEK) , University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Lukas Klein
- Department of Orthopaedics and Trauma Surgery, Medical Center-University of Freiburg, Hugstetter Straße 55, Freiburg, Baden-Württemberg, 79106, GERMANY
| | - Marvin L Beusterien
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Marc Mueller
- Sanitaetshaus Pfaender, Munzinger Straße 5c, Freiburg, 79111, GERMANY
| | | | - Carsten Mehring
- Institute of Biology III & Bernstein Centre , University of Freiburg, Hansastr. 9a, Freiburg im Breisgau, Baden-Württemberg, 79098, GERMANY
| | - Georg W Herget
- Department of Orthopaedics and Trauma Surgery, Medical Center-University of Freiburg, Hugstetter Straße 55, Freiburg, Baden-Württemberg, 79106, GERMANY
| | - Thomas Stieglitz
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Köhler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
| | - Cristian Pasluosta
- Laboratory for Biomedical Micro-technology, Department of Microsystem Engineering (IMTEK), University of Freiburg, Georges-Koehler-Allee 201, Freiburg im Breisgau, Baden-Württemberg, 79110, GERMANY
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Sarroca N, Luesma MJ, Valero J, Deus J, Casanova J, Lahoz M. Muscle Activation during Gait in Unilateral Transtibial Amputee Patients with Prosthesis: The Influence of the Insole Material Density. J Clin Med 2021; 10:jcm10143119. [PMID: 34300285 PMCID: PMC8306022 DOI: 10.3390/jcm10143119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Walking is a complex process that is highly automated and efficient. This knowledge is essential for the study of pathological gait. The amputation of lower limbs involves new biomechanical load and gait patterns, and injuries due to overload or disuse may occur. The objective of this study is to assess muscle activation as part of the gait in unilateral transtibial amputee patients with prosthesis, at different speeds and with different plantar supports. Method: Included in the sample were 25 people with amputation and 25 control participants. Muscle activation was evaluated in both groups by means of surface electromyography (EMG) under normal and altered conditions. Results: Control participants did not show statistically significant differences (p ˃ 0.05) between their muscle groups, irrespective of support and speed. However, people with amputation did show differences in muscle activity in the quadriceps, all of which occurred at the highest speeds, irrespective of support. In the analysis between groups, significant differences (p < 0.05) were obtained between the leg of the amputee patient and the leg of the control participant, all of them in the quadriceps, and at speeds 3 and 4, regardless of the insole used. Conclusions: Participants with unilateral transtibial amputation carry out more quadriceps muscle activity during gait compared to the control group.
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Affiliation(s)
- Nuria Sarroca
- Private Practice, Madre Vedruna 14 Bajo Derecho, 50008 Zaragoza, Spain;
| | - María José Luesma
- Department of Human Anatomy and Histology, University of Zaragoza, 50009 Zaragoza, Spain;
- Correspondence: ; Tel.: +34-656-230-642
| | - José Valero
- Private Practice, Coso 55, 50001 Zaragoza, Spain;
| | - Javier Deus
- Department of Surgery, University Hospital, 50009 Zaragoza, Spain;
| | | | - Manuel Lahoz
- Department of Human Anatomy and Histology, University of Zaragoza, 50009 Zaragoza, Spain;
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Santos IPD, Silva ADM, Furtado GS, Menezes RMMD, Santos KOBD, Ferraz DD. Patient’s satisfaction with a lower limb prosthesis: a longitudinal study. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20014728032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant’s satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant’s satisfaction with the LLP was high and did not change significantly over time.
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Bateni H. Postural Sway in Lower Extremity Amputees and Older Adults May Suggest Increased Fall Risk in Amputees. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 3:33804. [PMID: 37614402 PMCID: PMC10443479 DOI: 10.33137/cpoj.v3i2.33804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Falls can be detrimental to overall health and quality of life for lower extremity amputees. Most previous studies of postural steadiness focus on quantification of time series variables extracted from postural sway signals. While it has been suggested that frequency domain variables can provide more valuable information, few current studies have evaluated postural sway in amputees using frequency domain variables. METHODOLOGY Participants were assigned to 3 groups: lower extremity amputation (n=6), healthy young adults (n=10), and healthy older adults (n=10). Standing barefoot on a force platform, each individual completed 3 trials of each of 3 standing conditions: eyes open, eyes closed, and standing on a foam balance pad. Time and frequency domain variables of postural sway were computed and analyzed. RESULTS Comparison of older adults, younger adults, and amputees on the three conditions of standing eyes open, eyes closed, and on foam revealed significant differences between groups. Mean mediolateral (ML) sway distance from the center of pressure (COP), total excursions and sway velocity was significantly higher for amputees and older adults when compared to young adults (p<0.05). Furthermore, power of sway signal was substantially lower for both amputees and older adults. When compared to that of older adults, postural steadiness of amputees was more affected by the eyes closed condition, whereas older adults' was more affected when sensory and proprioceptive information was perturbed by standing on foam. CONCLUSION Our findings showed that fall risk is greater in amputees than in young adults without amputation. Additionally, amputees may rely more heavily on visual information than proprioceptive information for balance, in contrast to older and young adults without amputation.
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Affiliation(s)
- H. Bateni
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, Illinois, USA
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ARIFIN NOORANIDA, ABU OSMAN NOORAZUAN, ALI SADEEQ. POSTURAL STABILITY STRATEGIES IN TRANSTIBIAL AMPUTEES DURING QUIET STANDING IN ALTERED SENSORY CONDITIONS WEARING THREE TYPES OF PROSTHETIC FEET. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Individuals with transtibial amputation exhibit altered movement strategy to sustain stability during quiet standing due to reduced proprioception on the amputated limb. The aim of this study is to determine the movement strategies in anterior–posterior and medial–lateral directions in predicting the overall postural stability. In this crossover study, postural stability of ten transtibial amputees was assessed using computed posturography while wearing different prosthetic foot types: solid ankle cushion heel (SACH), single axis (SA) and energy storage and return (ESAR). Three stability indices were measured during four conditions: standing with eyes opened and closed, standing on compliant surface and standing with tilted head. From the standard multiple regression analysis, 63% to 99% of the OSI score in all sensory conditions were explained from the MLSI score, while 11% to 56% from the APSI score. The Pearson’s [Formula: see text] indicated significant strong positive relationship between OSI and MLSI [Formula: see text]–[Formula: see text] during all sensory conditions. The APSI score was significantly lower than OSI during eyes-closed and head extended conditions for all prosthetic feet [Formula: see text]. Adjustments in postural stability strategies in transtibial amputees mostly occurred in medial–lateral direction regardless of prosthetic feet types and altered sensory conditions.
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Affiliation(s)
- NOORANIDA ARIFIN
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Center for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - NOOR AZUAN ABU OSMAN
- Center for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
- The Chancellery, University of Malaysia Terengganu, 21030 Terengganu, Malaysia
| | - SADEEQ ALI
- Department of Occupational Therapy and Orthopedic Engineering, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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Thomas-Pohl M, Villa C, Davot J, Bonnet X, Facione J, Lapeyre E, Bascou J, Pillet H. Microprocessor prosthetic ankles: comparative biomechanical evaluation of people with transtibial traumatic amputation during standing on level ground and slope. Disabil Rehabil Assist Technol 2019; 16:17-26. [PMID: 31535903 DOI: 10.1080/17483107.2019.1629112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The compensations occurrence due to the alteration of the posture and the gait of persons with lower limb amputation is still an issue in prosthetic fitting. Recently, prosthetic feet designed to reproduce the physiological behaviour of the ankle using a microprocessor control have been commercialized to address this issue. OBJECTIVES Investigate the relevance of these microprocessor prosthetic ankles (MPAs) in the ability of standing on both level and inclined surfaces. METHODS Six persons with transtibial amputation usually fitted with energy storing and returning (ESR) foot tested three MPAs: Elan® Endolite (MPA1), Meridium® Ottobock (MPA2), ProprioFoot® Ossur (MPA3). Each MPA data acquisition was preceded of a 2 weeks adaptation period at home and followed by a 3-weeks wash-out period with their ESR. Lower limb angular position and moment, Centre of Pressure (CoP) position, Ground Reaction Forces (GRF) and functional scores were collected in static, on level ground and 12% inclined slope. RESULTS MPAs allowed a better posture and a reduction of residual knee moment on positive and/or negative slope compared to ESR. Results also reflect that the MPA2 allows the best control of the CoP in all situations. CONCLUSIONS An increased ankle mobility is associated with a better posture and balance on slope. Gait analysis would complete these outcomes. CLINICAL RELEVANCE This study compares three MPAs to ESR analysing static posture. Static analysis on level ground and slope represents the challenging conditions people with amputation have to cope with in their daily life, especially outdoors. Having a better understanding of the three MPAs behaviour could help to adequately fit the prosthesis to each patient. Implications for rehabilitation This is a study comparing three MPAs. The static analysis in standard and constraining conditions (slope) reflects the balance of people with amputation in their daily life, especially outdoors. Having a better understanding of the behaviour of each foot could help to adequately fit the prosthesis to each patient.
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Affiliation(s)
- Marie Thomas-Pohl
- Service de Médecine Physique et de Réadaptation, Hôpital D'Instruction Des Armées Percy, Clamart, France
| | - C Villa
- INI, Centre D'étude et de Recherche Sur L'appareillage Des Handicapés (CERAH), Créteil, France.,Arts et Metiers Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - J Davot
- INI, Centre D'étude et de Recherche Sur L'appareillage Des Handicapés (CERAH), Créteil, France
| | - X Bonnet
- Arts et Metiers Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - J Facione
- Service de Médecine Physique et de Réadaptation, Hôpital D'Instruction Des Armées Percy, Clamart, France
| | - E Lapeyre
- Service de Médecine Physique et de Réadaptation, Hôpital D'Instruction Des Armées Percy, Clamart, France
| | - J Bascou
- INI, Centre D'étude et de Recherche Sur L'appareillage Des Handicapés (CERAH), Créteil, France.,Arts et Metiers Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - H Pillet
- Arts et Metiers Institut de Biomécanique Humaine Georges Charpak, Paris, France
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Ozdil A, Iyigun G, Kalyoncu C. The comparison of clinical and computerized measurement of sitting balance in stroke patients and healthy individuals. NeuroRehabilitation 2019; 44:361-368. [DOI: 10.3233/nre-182634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Aytul Ozdil
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Famagusta, North Cyprus, via Mersin –10 Turkey
| | - Gozde Iyigun
- Eastern Mediterranean University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Famagusta, North Cyprus, via Mersin –10 Turkey
| | - Cem Kalyoncu
- European University of Lefke, Faculty of Engineering, Computer Engineering Department, Lefke, TR-10, Turkey
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13
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Rusaw DF. Adaptations from the prosthetic and intact limb during standing on a sway-referenced support surface for transtibial prosthesis users. Disabil Rehabil Assist Technol 2018; 14:682-691. [DOI: 10.1080/17483107.2018.1498925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David F. Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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14
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Wanamaker AB, Andridge RR, Chaudhari AM. When to biomechanically examine a lower-limb amputee: A systematic review of accommodation times. Prosthet Orthot Int 2017; 41:431-445. [PMID: 28946826 DOI: 10.1177/0309364616682385] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hundreds of investigations examining biomechanical outcomes of various prostheses have been completed, but one question remains unanswered: how much time should an amputee be given to accommodate to a new prosthesis prior to biomechanical testing? OBJECTIVE To examine the literature for accommodation time given during biomechanical investigations to determine whether consensus exists. STUDY DESIGN Systematic review. METHODS A systematic search was completed on 7 January 2016 using PubMed and Scopus. RESULTS The search resulted in 156 investigations. Twenty-eight studies did not provide an accommodation or were unclear (e.g. provided a "break in period"), 5 studies tested their participants more than once, 25 tested only once and on the same day participants received a new prosthesis (median (range): above-knee: 60 (10-300) min; below-knee: 18 (5-300) min), and 98 tested once and gave a minimum of 1 day for accommodation (hip: 77 (60-180) days; above-knee: 42 (1-540) days; below-knee: 21 (1-475) days). CONCLUSION The lack of research specifically examining accommodation and the high variability in this review's results indicates that it remains undecided how much accommodation is necessary. There is a need for longitudinal biomechanical investigations to determine how outcomes change as amputees accommodate to a new prosthesis. Clinical relevance The results of this review indicate that little research has been done regarding lower-limb amputees accommodating to a new prosthesis. Improper accommodation could lead to increased variability in results, results that are not reflective of long-term use, and could cause clinicians to make inappropriate decisions regarding a prosthesis.
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15
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Individuals with transtibial limb loss use interlimb force asymmetries to maintain multi-directional reactive balance control. Clin Biomech (Bristol, Avon) 2014; 29:1039-47. [PMID: 25200883 PMCID: PMC4337775 DOI: 10.1016/j.clinbiomech.2014.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deficits in balance control are one of the most common and serious mobility challenges facing individuals with lower limb loss. Yet, dynamic postural balance control among individuals with lower limb loss remains poorly understood. Here we examined the kinematics and kinetics of dynamic balance in individuals with unilateral transtibial limb loss. METHODS Five individuals with unilateral transtibial limb loss, and five age- and gender-matched controls completed a series of randomly applied multi-directional support surface translations. Whole-body metrics, e.g. peak center-of-mass displacement and net center-of-pressure displacement were compared across cohorts. Stability margin was computed as the difference between peak center-of-pressure and center-of-mass displacement. Additionally, center-of-pressure and ground reaction force magnitude and direction were compared between the prosthetic, intact, and control legs. FINDINGS Peak center-of-mass displacement and stability margin did not differ between individuals with transtibial limb loss and controls for all perturbation directions except those loading only the prosthetic leg; in such cases the stability margin was actually larger than controls. Despite similar center-of-mass displacement, greater center-of-pressure displacement was observed in the intact leg during anterior-posterior perturbations, and under the prosthetic leg in medial-lateral perturbations. Further, in the prosthetic leg, ground reaction forces were smaller and spanned fewer directions. INTERPRETATION Deficits in balance control among individuals with transtibial limb loss may be due to their inability to use their prosthetic leg to generate forces that are equal in magnitude and direction to those of unimpaired adults. Targeting this force-generating deficit through technological or rehabilitation innovations may improve balance control.
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