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Butowicz C, Yoder AJ, Hendershot BD, Gunterstockman B, Farrokhi S. Principal components analysis of postural sway in persons with unilateral lower limb amputation: A wearable sensor approach. J Biomech 2023; 158:111768. [PMID: 37625201 DOI: 10.1016/j.jbiomech.2023.111768] [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: 12/16/2022] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Standing sway assessments can detect sensory imbalances which compromise postural control. Persons with lower limb amputation (LLA) often demonstrate impaired postural control, increasing fall risk. Here, principal features of postural sway were identified in persons with unilateral LLA using a single, commercially available wearable sensor. Sixty-one persons with LLA (n = 44 transtibial; n = 17 transfemoral) stood on a firm surface with eyes open/closed while wearing a single accelerometer mounted over the sacrum. Common parameters quantified spatiotemporal and spectral features of sway in anterior-posterior (AP) and mediolateral (ML) directions. Principal component (PC) dimensionality reduction was applied and loadings inspected to identify a reduced, non-redundant set among 14 original variables capturing 90 % variance. Six PCs described ≥ 90 % variance, with the first 3 explaining 75 %. With eyes open and closed, PC1 was loaded by variables characterizing trajectory planar size: area, jerk (i.e., sway smoothness), AP/ML RMS path distance, and AP/ML path range. With eyes open, PC2 was loaded by variables characterizing direction and spectral features: ellipse rotation, AP centroidal frequency, and ML jerk. With eyes closed, PC2 spectral loadings increased: ML centroidal frequency, ML frequency dispersion, and AP centroidal frequency. With eyes open, PC3 was loaded by ellipse rotation, jerk, ML velocity, ML centroidal frequency. With eyes closed, PC3 was loaded by ellipse rotation, ML centroidal frequency, ML frequency dispersion, and AP path velocity, characterizing off-axis error/corrections. RMS of path distance, ellipse rotation, centroidal frequency, frequency dispersion, path velocity, and jerk are a concise parameter set, derived from an accelerometer, to capture principal sway features in persons with LLA during standing balance with visual perturbations.
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Affiliation(s)
- Courtney Butowicz
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
| | - Adam J Yoder
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States
| | - Brad D Hendershot
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
| | - Brittney Gunterstockman
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States; Department of Physical Therapy, Lincoln Memorial University, Knoxville, TN 37932, United States
| | - Shawn Farrokhi
- Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States; Department of Physical & Occupational Therapy, Naval Medical Center, San Diego, CA 92134, United States
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Finco MG, Sumien N, Moudy SC. Clinical evaluation of fall risk in older adults who use lower-limb prostheses: A scoping review. J Am Geriatr Soc 2023; 71:959-967. [PMID: 36648090 PMCID: PMC10023358 DOI: 10.1111/jgs.18223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND No reviews or evidence-based clinical protocols exist to evaluate fall risk in older adults who use lower-limb prostheses, despite falls being prevalent and costly in this population. This scoping review sought to determine assessments, defined as clinical outcome measures and gait parameters, associated with fall risk in this population to determine if a systematic review is warranted and help inform an evidence-based clinical protocol. METHODS Google Scholar, PubMed, and Scopus were searched on April 19th, 2022 to include peer-reviewed original research. Included articles reported relationships between falls and clinical outcome measures or gait parameters in older adults who use transtibial or transfemoral prostheses. Clinical outcome measures included self-reported questionnaires and functional mobility tests. Gait parameters included spatiotemporal, kinematic, and kinetic data during walking and stair negotiation. RESULTS Nineteen articles were included. Clinical outcome measure scores, gait parameter data, and cutoff scores by fall status (nonfallers, single fallers, recurrent fallers) were summarized. Six articles determined clinical outcome measures that had statistically significant associations with falls, and two articles determined gait parameters that had statistically significant associations with falls. CONCLUSIONS The majority of articles found no clinical outcome measure or gait parameter alone was effective at identifying fall risks in this population. Future research should evaluate a combination of assessments and collect prospective fall data to move towards establishing an evidence-based protocol to evaluate fall risk in older adults using lower-limb prostheses.
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Affiliation(s)
- M G Finco
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Nathalie Sumien
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sarah C Moudy
- Department of Family and Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Assessment of the relationship between rectus femoris cross-sectional area and knee extension strength in the prosthesis users with transtibial amputation: A case-control study. Turk J Phys Med Rehabil 2022; 68:222-230. [PMID: 35989968 PMCID: PMC9366482 DOI: 10.5606/tftrd.2022.7655] [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: 10/21/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to investigate cross-sectional area of the amputated-limb rectus femoris compared to the intact-limb and controls and to determine its correlation with functional strength and walking tests in prosthesis users with transtibial amputation.
Patients and methods
Between October 2018 and April 2019, a total of 14 prosthesis users (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) who met the inclusion criteria, and 14 age-, sex-, and dominancy-matched able-bodied controls (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) were included in this case-control study. Cross-sectional area of rectus femoris (CSA-RF) was evaluated bilaterally by two independent examiners. Knee extension strength was measured bilaterally by using a handheld dynamometer. Functional strength and walking were assessed by Step-Up-Over and Walk-Across tests of the NeuroCom Balance Master® device.
Results
The CSA-RF was found to be reduced in amputated-limb compared to the intact-limb and able-bodied controls (p<0.01). In the prosthesis users, the cross-sectional area difference between both limbs rectus femoris muscles was shown to be correlated with actual and functional knee extension strength, step length, and walking speed (p<0.05). Intra- and inter-observer reliability of CSA-RF on both sides were found to be good to excellent (intraclass correlation coefficient: 0.856-0.936).
Conclusion
Ultrasonographic measurement of CSA-RF is a valid and reliable tool to assess the functional strength and walking in the prosthesis users with unilateral transtibial amputation.
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Nugent K, Payne MW, Viana R, Hunter SW. The reliability of four standardized concern for falling scales among adults with a major lower extremity amputation. PM R 2022; 15:437-444. [PMID: 35150095 DOI: 10.1002/pmrj.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION More than 52.4% of people with a lower extremity amputation (PLEA) will fall at least once each year. Previously established standardized scales which evaluate a concern for falling (CFF) were primarily developed among community dwelling older adults. The reliability of commonly used scales to evaluate a CFF among PLEA is needed. OBJECTIVE To evaluate test-retest relative and absolute reliability, and agreement of the Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Falls Efficacy Scale - International (FES-I), Consequences of Falling (COF) Scale, Perceived Control Over Falling (PCOF) Scale, and Perceived Ability to Manage Falls (PAMF) Scale among PLEA. DESIGN Web-based cross-sectional repeated measures study. SETTING Rehabilitation hospital. PARTICIPANTS Regularly scheduled appointments (N = 22, mean age ± SD, 63.5 ± 12.9 years) with a transtibial or transfemoral level amputation, completed a prosthetic rehabilitation program, and at minimum of one year using a prosthesis for ambulation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Initial and re-test scores on the mSAFFE, FES-I, COF, PAMF, and PCOF. RESULTS Intraclass correlation coefficients (ICC) demonstrated excellent relative reliability of the mSAFFE [ICC = 0.92 (95% CI: 0.82-0.97)], good relative reliability of the FES-I [ICC = 0.87 (95% CI: 0.70-0.94)], and fair relative reliability of the COF [ICC = 0.78 (95% CI: 0.53-0.90)] and PAMF [ICC = 0.73 (95% CI: 0.46-0.88)] scales. The ICC value of the PCOF scale could not be validly calculated and was not further analyzed. Calculated SE of measurement values for the mSAFFE, FES-I, COF, and PAMF scales were small in magnitude and Bland-Altman graphs demonstrated good agreement of initial and re-test scores for all scales. CONCLUSION This study provides initial evidence on the suitability and reliable use of the mSAFFE, FES-I, COF, and PAMF scales within this population. Further evaluation of the validity of these scales is needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kristin Nugent
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Michael W Payne
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Ricardo Viana
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Kolářová B, Janura M, Svoboda Z, Kolář P, Tečová D, Elfmark M. Postural Control Strategies and Balance-Related Factors in Individuals with Traumatic Transtibial Amputations. SENSORS 2021; 21:s21217284. [PMID: 34770589 PMCID: PMC8587115 DOI: 10.3390/s21217284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/18/2023]
Abstract
Mechanisms behind compromised balance control in people with transtibial amputation need to be further explored, as currently little is known specifically about postural control strategies in people with traumatic transtibial amputation (tTTA). The aim of this study is to assess automatic and voluntary postural control strategies in individuals with unilateral tTTA compared to those in control subjects and to define the effect of balance-related factors on these strategies. Automatic posture reactions and volitional motion toward given direction using standardized posturographic protocols (NeuroCom) of the Motor Control Test (MCT) and Limits of Stability (LOS) were assessed in eighteen participants with tTTA and eighteen age-matched controls. Compared to the controls, the participants with tTTA bore less weight on the prosthetic leg (p < 0.001) during the MCT and had reduced inclination toward the prosthetic leg (p < 0.001) within the LOS. In the tTTA group, the weight-bearing symmetry and the inclination toward the prosthetic leg (p < 0.05) was positively correlated with prosthesis use duration (p < 0.05). The current study indicates that decreased utilization of the prosthetic leg in tTTAs represents adaptive postural control strategy, but as prosthesis use duration increased, the engagement of the prosthetic leg improved.
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Affiliation(s)
- Barbora Kolářová
- Kinesiology Laboratory, Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic;
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
- Correspondence:
| | - Miroslav Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
| | - Zdeněk Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
| | - Petr Kolář
- Kinesiology Laboratory, Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic;
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
| | - Dagmar Tečová
- Department of Clinical Rehabilitation, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic;
| | - Milan Elfmark
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11 Olomouc, Czech Republic; (M.J.); (Z.S.); (M.E.)
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Vimal AK, Verma V, Khanna N, Joshi D. Investigating the Effect of Vibrotactile Feedback in Transfemoral Amputee With and Without Movable Ankle Joint. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2890-2900. [PMID: 33156790 DOI: 10.1109/tnsre.2020.3035833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The loss of somatosensory feedback after transfemoral amputation imposes a serious challenge in achieving postural stability. In the recent past, weight shifting exercises with fixed ankle joint have been reported useful in boosting the limit of stability (LOS) only in the sound limb; the LOS on the prosthetic limb did not improve. A fixed ankle joint restricts movement in the anterior-posterior direction at the ankle level. Thus, it may suppress the ability to move forward LOS despite awareness of center of pressure (COP) due to vibrotactile feedback. Therefore, it could have limited the improvement in the LOS of a prosthetic limb in previous studies. This article investigates this hypothesis by evaluating the effect of vibrotactile feedback in the LOS of transfemoral amputees with fixed as well as movable ankle joints. This evaluation is done during weight shifting exercises. Firstly, we developed an in-house COP guided vibrotactile sensory feedback system. Next, we recruited five transfemoral amputees to perform a weight-shifting exercise with a) fixed ankle joint (single-axis cushion heel (SACH) foot) and b) movable ankle joint (single-axis foot). Finally, we analyzed the recorded center of pressure trajectory signals for the limit of stability. The findings of repeated measures ANOVA showed a marginally significant interaction ( [Formula: see text], [Formula: see text], [Formula: see text]) between ankle joint and feedback conditions during backward shifting in weight shifting exercise. Further analysis showed that during the backward shifting fixed ankle joint did not improve in the presence of vibrotactile feedback, while a marginally significant ( [Formula: see text]) improved LOS was observed in the movable ankle joint with feedback. The findings conclude that the vibrotactile feedback is more effective in transfemoral amputees with movable ankle joint compared with fixed ankle joint.
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The feasibility and validity of a wearable sensor system to assess the stability of high-functioning lower-limb prosthesis users. ACTA ACUST UNITED AC 2020; Online first. [PMID: 33510564 DOI: 10.1097/jpo.0000000000000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Lower-limb prosthesis users (LLPUs) experience increased fall risk due to gait and balance impairments. Clinical outcome measures are useful for measuring balance impairment and fall risk screening but suffer from limited resolution and ceiling effects. Recent advances in wearable sensors that can measure different components of gait stability may address these limitations. This study assessed feasibility and construct validity of a wearable sensor system (APDM Mobility Lab) to measure postural control and gait stability. Materials and Methods Lower-limb prosthesis users (n=22) and able-bodied controls (n=24) completed an Instrumented Stand-and-Walk Test (ISAW) while wearing the wearable sensors. Known-groups analysis (prosthesis versus controls) and convergence analysis (Prosthetic Limb Users Survey of Mobility [PLUS-M] and Activity-specific Balance Confidence [ABC] Scale) were performed on 20 stability-related measures. Results The system was applied without complications; however missing anticipatory postural adjustment data points for nine subjects affected the analysis. Of the 20 analyzed measures output by the sensors, only three significantly differed (p≤.05) between cohorts, and two demonstrated statistically significant correlations with the self-report measures. Conclusions The results of this study suggest the clinical feasibility but only partial construct validity of the wearable sensor system in conjunction with the ISAW test to measure LLPU stability and balance. The sample consisted of high-functioning LLPUs, so further research should evaluate a more representative sample with additional outcome measures and tasks.
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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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Kumar Vimal A, Kant Godiyal A, Singh U, Bhasin S, Joshi D. Transfemoral amputee’s limit of stability and sway analysis during weight shifting exercise with a vibrotactile feedback system. Somatosens Mot Res 2019; 36:31-41. [DOI: 10.1080/08990220.2019.1572602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Amit Kumar Vimal
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, India
- National Institute for Persons with Physical Disability (Divyangjan), Department of Empowerment of Persons With Disabilities, Ministry of Social Justice Empowerment, Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Kant Godiyal
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Upinderpal Singh
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Delhi, India
| | - Shubhendu Bhasin
- Department of Electrical Engineering, Indian Institute of Technology, Delhi, India
| | - Deepak Joshi
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, India
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Barnett CT, Vanicek N, Rusaw DF. Do Predictive Relationships Exist Between Postural Control and Falls Efficacy in Unilateral Transtibial Prosthesis Users? Arch Phys Med Rehabil 2018; 99:2271-2278. [PMID: 29920230 DOI: 10.1016/j.apmr.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users. DESIGN Twelve-month within- and between-participants repeated measures design. Participants performed the limits of stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups. SETTING University biomechanics laboratories. PARTICIPANTS Participants (N=24) included a group of active unilateral transtibial prosthesis users of primarily traumatic etiology (n=12) with at least 1 year of prosthetic experience and age- and sex-matched control participants (n=12). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Postural control variables derived from center of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely reaction time, movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL). Number of falls and total FES-I scores. RESULTS During the study period, the prosthesis users group had higher FES-I scores (U=33.5, P=.02), but experienced a similar number of falls, compared to the control group. Increased FES-I scores were associated with decreased EPE (r= -0.73, P=.02), MXE (r= -0.83, P<.01) and MVL (r= -0.7, P=.03) in the prosthesis users group, and DCL (r= -0.82, P<.01) in the control group, all in the backward direction. CONCLUSIONS Study baseline measures of postural control, in the backward direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.
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Affiliation(s)
- Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
| | - Natalie Vanicek
- School of Life Sciences, University of Hull, Hull, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Imam B, Miller WC, Finlayson HC, Eng JJ, Jarus T. A clinical survey about commercial games in lower limb prosthetic rehabilitation. Prosthet Orthot Int 2018; 42:311-317. [PMID: 29126375 DOI: 10.1177/0309364617740238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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 Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking. OBJECTIVES To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games. STUDY DESIGN Cross-sectional. METHODS An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives. RESULTS Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%). CONCLUSION Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.
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Affiliation(s)
- Bita Imam
- The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Janice J Eng
- The University of British Columbia, Vancouver, BC, Canada
| | - Tal Jarus
- The University of British Columbia, Vancouver, BC, Canada
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Shepherd MK, Rouse EJ. The VSPA Foot: A Quasi-Passive Ankle-Foot Prosthesis With Continuously Variable Stiffness. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2375-2386. [DOI: 10.1109/tnsre.2017.2750113] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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