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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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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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Correlates of Balance and Aerobic Indices in Lower-Limb Prostheses Users on Arm Crank Exercise. SENSORS 2021; 21:s21206917. [PMID: 34696129 PMCID: PMC8540364 DOI: 10.3390/s21206917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
Background: The HUMAC Balance System (HBS) offers valid measurement of balance, and the arm crank exercise test (ACE) is a valid measure of physiological capacity. Neither have been used to evaluate associations between balance and physiological capacity in lower-limb amputees. Methods: Thirty-five participants with lower-limb amputations were recruited. Standing balance (center of pressure) was evaluated during eyes opened (EO) and eyes closed (EC) conditions using the HBS. Participants performed ACE graded exercise testing (GXT) to evaluate aerobic capacity. Spearman’s rho was used to identify relationships between variables. Cut-points for three groups were generated for time on ACE. Mann–Whitney U tests were used to explore significant differences in variables of balance and ACE between low and high performers. Results: Relationships between variables of eyes open displacement (EOD), eyes open velocity (EOV), eyes closed displacement (ECD), and eyes closed velocity (ECV) were significant (p < 0.05), and high performers with EO also performed best with EC. Longer exercise times were significantly associated with increased HRpeak, VO2peak, VEpeak, and RERpeak (p < 0.05). HRpeak (143.0 ± 30.6 b/min), VO2peak (22.7 ± 7.9 and 10.6 ± 4.7 mL/kg/min), VEpeak (80.2 ± 22.2 and 33.2 ± 12.7 L/min), and RERpeak (1.26 ± 0.08 and 1.13 ± 0.11) were significantly greater in high performers than low performers, respectively (p < 0.05). There was no significant association among VO2peak and any balance task variables; however, there were significant associations between some balance and physiological variables. Conclusions: Findings differentiated high and low performers; however, participants were still well below able-bodied norms of physical capacity. Training to mitigate deconditioning is suggested.
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Mayes WH, Severin AC, Mannen EM, Edwards PK, Barnes CL, Stambough JB, Mears SC. Management of Periprosthetic Joint Infection and Extensor Mechanism Disruption With Modular Knee Fusion: Clinical and Biomechanical Outcomes. Arthroplast Today 2021; 8:46-52. [PMID: 33718555 PMCID: PMC7921710 DOI: 10.1016/j.artd.2020.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022] Open
Abstract
Background Extensor mechanism disruption (EMD) combined with periprosthetic joint infection (PJI) after total knee arthroplasty are life-changing complications. The literature suggests many eventually receive above-knee amputation and lose ambulatory function. An alternative is modular knee fusion (KF), but little is known about its outcomes and biomechanical function. We report early term results on a case series of patients. Methods A retrospective review was conducted of patients who underwent 2-stage reconstruction with modular KF for combined EMD and PJI. Patient-reported outcomes at 1 year after arthrodesis and complications of surgery were recorded. Biomechanical analysis was conducted on 6 patients >1 year after surgery to measure gait speed and balance. Results Fifteen patients received a modular KF. At the most recent follow-up visit (average 25.7 months), 12 patients had their modular KFs in place and were ambulatory while 2 had died. Six patients used a walker; 4, a cane; and 2, unassisted. Gait analysis of 6 of these patients showed variation in patterns and speed. Balance was better than historical controls treated with above-knee amputation. Average Knee Injury and Osteoarthritis Outcome Score Junior was 76 ± 11. Conclusion Modular KF for EMD and PJI can result in successful outcomes in terms of preventing additional operations and maintaining ambulation. While speed is variable, physical testing shows this method for limb salvage may allow patients to ambulate with a gait aid although further studies are needed to evaluate midterm and long-term results.
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Affiliation(s)
- Wesley H Mayes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anna C Severin
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Erin M Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paul K Edwards
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 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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Claret CR, Herget GW, Kouba L, Wiest D, Adler J, von Tscharner V, Stieglitz T, Pasluosta C. Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation. J Neuroeng Rehabil 2019; 16:115. [PMID: 31521190 PMCID: PMC6744715 DOI: 10.1186/s12984-019-0586-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/04/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Following an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation. METHODS Center of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG). RESULTS There was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p < 0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p < 0.001), CoP velocity (p < 0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = - 0.59, EC: ρ = - 0.69). CONCLUSION These results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control. TRIAL REGISTRATION DRKS00015254 , registered on September 20th, 2018.
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Affiliation(s)
- Claudia Ramos Claret
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Georg W Herget
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Kouba
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany.
- BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany.
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.
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Leirós-Rodríguez R, García-Soidán JL, Romo-Pérez V. Analyzing the Use of Accelerometers as a Method of Early Diagnosis of Alterations in Balance in Elderly People: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3883. [PMID: 31505828 PMCID: PMC6767154 DOI: 10.3390/s19183883] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
Alterations of balance are a growing public health problem as they affect one in three adults over the age of 65, and one in two over the age of 80. Identifying the factors that affect postural stability is essential in designing specific interventions to maintain the independence and mobility of older people. The aim of this review was to understand the use of accelerometers in order to assess the balance in older people. Analyzing the most appropriate evaluation methodology and protocolizing it will optimize the processes of early identification of balance alterations. However, quantitative assessment methods of balance are usually limited to a laboratory environment, a factor that can be overcome by accelerometers. A systematic search was carried out across eight databases where accelerometers were employed to assess balance in older people. Articles were excluded if they focused on sensor design and did not measure balance or apply the technology on targeted participants. A total of 19 articles were included for full-text analysis, where participants took part in the balance evaluation monitored by accelerometers. The analysis of spatio-temporal parameters and the magnitude of the accelerations recorded by the devices were the most common study variables. Accelerometer usage has potential to positively influence interventions based on physical exercise to improve balance and prevent falls in older people.
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Affiliation(s)
- Raquel Leirós-Rodríguez
- Faculty of Physical Therapy, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
| | - Jose L García-Soidán
- Faculty of Education and Sport Sciences, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
| | - Vicente Romo-Pérez
- Faculty of Education and Sport Sciences, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
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Functional and postural recovery after bilateral or unilateral total hip arthroplasty. J Electromyogr Kinesiol 2019; 48:205-211. [PMID: 31442926 DOI: 10.1016/j.jelekin.2019.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/30/2019] [Accepted: 08/09/2019] [Indexed: 01/27/2023] Open
Abstract
One-stage bilateral total hip arthroplasty (THA) implies similar complication rate and hospitalization time to unilateral THA, but no studies have evaluated the functional and postural recovery in these patients. The aim of this study was to assess short-term functional and postural recovery in patients after one-stage bilateral or unilateral THA. Forty patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were assessed by Timed Up and Go (TUG), Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK) and Body Weight Distribution Symmetry Index (BWDSI) during stand-to-sit (STS). Centre of Pressure (CoP) parameters and BWDSI during standing with eyes open (EO) and closed (EC) were also assessed. Data were collected one day before surgery, at three and seven days. No between-group differences were found for TUG, NRS and TSK at any time-point, showing similar mobility, pain and fear of movement in both groups. BWDSI during STS (P = 0.001) and standing (OE P = 0.007; CE P = 0.012) revealed differences over time in favor of patients with bilateral THA, who showed better symmetry in weight distribution. Shorter CoP path length was observed during standing in patients with unilateral THA (OE P = 0.023; CE P = 0.018), who mainly used their non-affected limb to maintain balance.
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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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Ernst M, Altenburg B, Bellmann M, Schmalz T. Standing on slopes - how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task. J Neuroeng Rehabil 2017; 14:117. [PMID: 29145876 PMCID: PMC5691831 DOI: 10.1186/s12984-017-0322-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. METHODS Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. RESULTS Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. CONCLUSIONS A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such situations, this prosthetic concept appears superior to both, conventional feet with passive structures as well as feet that solely provide a sufficient range of motion. The results also indicate that both, transfemoral and transtibial amputees benefit from such a foot.
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Affiliation(s)
- Michael Ernst
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Björn Altenburg
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Malte Bellmann
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
| | - Thomas Schmalz
- Research Biomechanics, CR&S, Otto Bock HealthCare GmbH, Göttingen, Germany
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Wang D, Cai P, Mao Z. The configuration of plantar pressure sensing cells for wearable measurement of COP coordinates. Biomed Eng Online 2016; 15:116. [PMID: 27784299 PMCID: PMC5080789 DOI: 10.1186/s12938-016-0237-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 10/09/2016] [Indexed: 11/24/2022] Open
Abstract
Background Wearable measurement of center of pressure (COP) coordinates is the key of obtaining the measurement of natural gait. Plantar pressure insole is the right sensing unit for plantar pressure monitoring for long-term outdoor measurements and the control of walking assisting exoskeleton robot. It’s necessary to study the configuration of pressure sensing cells. Methods This study explored the sensing cell configuration for the plantar pressure insole. The data of plantar pressure of walking is collected for layout variants. The RMSE of COP coordinates estimations are used as the evaluation criteria. Results The RMSE of COP coordinates decreases from 8.00 to 3.20 mm as the amount of pressure sensing cells increases from 2 to 7. The size of pressure sensing cells contribute to reduce the RMSE of COP coordinates and 7 pressure sensing cells, with the size of 2.0–2.5 cm have the satisfying performance. Adding pressure sensing cell in the heel and hallux area increase the accuracy of estimating COP coordinates. Conclusion Comparison results indicate that the configuration of 7 pressure sensing cells has a satisfying measurement performance.
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Affiliation(s)
- Dian Wang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.,Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Shanghai, 200240, China
| | - Ping Cai
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China. .,Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Shanghai, 200240, China.
| | - Zhiyong Mao
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.,Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Shanghai, 200240, China
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Mikó I, Szerb I, Szerb A, Poor G. Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial. Clin Rehabil 2016; 31:217-224. [PMID: 26825109 DOI: 10.1177/0269215516628616] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis. DESIGN Randomized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment. SUBJECTS A total of 100 osteoporotic women - at least with one osteoporotic fracture - aged 65 years old and above. MAIN MEASURES Balance was assessed in static and dynamic posture both with performance-based measures of balance, such as the Berg Balance Scale and the Timed Up and Go Test, and with a stabilometric computerized platform. INTERVENTIONS Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting, guided by physical therapists, three times a week, for 30 minutes. RESULTS The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005, respectively). Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme. As a consequence, the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group. CONCLUSION The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past.
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Affiliation(s)
- Ibolya Mikó
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | - Anna Szerb
- 3 The London School of Economics and Political Science, London, UK
| | - Gyula Poor
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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Arifin N, Abu Osman NA, Ali S, Gholizadeh H, Wan Abas WAB. Evaluation of postural steadiness in below-knee amputees when wearing different prosthetic feet during various sensory conditions using the Biodex® Stability System. Proc Inst Mech Eng H 2015; 229:491-8. [PMID: 26019139 DOI: 10.1177/0954411915587595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/27/2015] [Indexed: 11/17/2022]
Abstract
In recent years, computerized posturography has become an essential tool in quantitative assessment of postural steadiness in the clinical settings. The purpose of this study was to explore the ability of the Biodex(®) Stability System (BSS) to quantify postural steadiness in below-knee amputees. A convenience sample of 10 below-knee amputees participated in the study. The overall (OSI), anterior-posterior (APSI) and medial-lateral (MLSI) stability indexes as well as the percentage of time spent in left and right quadrants and four concentric zones were measured under altered sensory conditions while standing with solid ankle cushion heel (SACH), single-axis (SA) and energy storage and release (ESAR) feet. Significant difference was found between sensory conditions in SACH and ESAR feet for OSI (SACH, p = 0.002; ESAR, p = 0.005), APSI (SACH, p = 0.036; ESAR, p = 0.003) and MLSI (SACH, p = 0.008; ESAR, p = 0.05) stability indexes. The percentage of time spent in Zone A (0°-5°) was significantly greater than the other three concentric zones (p < 0.01). The loading time percentage on their intact limb (80%-94%) was significantly longer than the amputated limb (20%-6%) in all conditions for all three prosthetic feet. Below-knee amputees showed compromised postural steadiness when visual, proprioceptive or vestibular sensory input was altered. The findings highlight that the characteristics of postural stability in amputees can be clinically assessed by utilizing the outcomes produced by the BSS.
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Affiliation(s)
- Nooranida Arifin
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Sadeeq Ali
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hossein Gholizadeh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Abu Bakar Wan Abas
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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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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The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees. Biomed Eng Online 2014; 13:23. [PMID: 24597518 PMCID: PMC3975715 DOI: 10.1186/1475-925x-13-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/26/2014] [Indexed: 11/16/2022] Open
Abstract
Background Achieving independent upright posture has known to be one of the main goals in rehabilitation following lower limb amputation. The purpose of this study was to compare postural steadiness of below knee amputees with visual alterations while wearing three different prosthetic feet. Methods Ten male below-knee amputees were instructed to stand quietly on the Biodex® balance platform while wearing solid ankle cushion heel (SACH), single axis (SA) and energy storage and release (ESAR) prosthetic foot under different visual input conditions (eyes-opened and eyes-closed). The overall stability index (OSI), anterior- posterior stability index (APSI), and medial-lateral stability index (MLSI) were computed. Perceived balance assessment of each foot was evaluated using Activities-specific Balance Confidence (ABC) score. Results The findings highlights that SACH showed lowest overall stability index (indicating less body sway) during eyes-opened (OSI: SACH = 1.09, SA = 1.58, ESAR = 1.59) and SA showed lowest overall stability index during eyes-closed (OSI: SACH = 2.52, SA = 2.30, ESAR = 2.76) condition. However, overall stability indexes between foot types did not differ significantly during eyes-opened or eyes-closed (p = 0.651). There was a trend of instability which occurred more in medial-lateral compared to anterior-posterior direction for all foot types, with significant result in ESAR foot(eyes-opened: MLSI = 1.59, APSI = 0.65, p = 0.034; eyes-closed: MLSI = 2.76, APSI = 1.80, p = 0.017, respectively). When comparing between visual conditions, stability score was significantly higher during eyes-closed compared to eyes-opened situations for SACH and ESAR foot (eyes-closed vs opened; SACH OSI: 3.43 vs 1.71, p = 0.018 and MLSI: 3.43 vs 1.71, p = 0.018; ESAR OSI: 3.58 vs 1.86, p = 0.043 and APSI: 1.80 vs 0.65, p = 0.027). Conclusions The results of this study suggested postural steadiness in below-knee amputees was not affected by the types of prosthetic foot during quiet upright standing, but was significantly affected when visual cues was absent.
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Balance control in lower extremity amputees during quiet standing: a systematic review. Gait Posture 2014; 39:672-82. [PMID: 24331296 DOI: 10.1016/j.gaitpost.2013.07.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 02/02/2023]
Abstract
Postural control has been widely evaluated for the normal population and different groups over the past 20 years. Numerous studies have investigated postural control in quiet standing posture among amputees. However, a comprehensive analysis is lacking on the possible contributing factors to balance. The present systematic review highlights the current findings on variables that contribute to balance instability for lower extremity amputees. The search strategy was performed on PubMed, Web of Science, Medline, Scopus, and CINAHL and then followed by additional manual searching via reference lists in the reviewed articles. The quality of the articles was evaluated using a methodological quality assessment tool. This review included and evaluated a total of 23 full-text articles. Despite the inconsistencies in the methodological design of the studies, all articles scored above the acceptable level in terms of quality. A majority of the studies revealed that lower extremity amputees have increased postural sway in the standing posture. Asymmetry in body weight, which is mainly distributed in the non-amputated leg, was described. Aside from the centre of pressure in postural control, sensory inputs may be a related topic for investigation in view of evidence on their contribution, particularly visual input. Other balance-related factors, such as stump length and patients' confidence level, were also neglected. Further research requires examination on the potential factors that affect postural control as the information of standing postural is still limited.
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Abstract
OBJECTIVE Lower-limb amputation is mainly a result of trauma, vascular disease, diabetes, or congenital disorders. Persons with amputation lose their ability to stand and walk on the basis of the level of amputation. Contribution of level of amputation, type of amputation, or cause of amputation to balance impairment has not been clearly defined. Furthermore, it is controversial how much the mentioned parameters influence standing stability. Therefore, the aim of this review article was to find the relationship between the abovementioned factors and balance impairment in the available literature. It was also aimed to find the possibility of improving standing stability by the use of different prosthesis components. DESIGN An electronic search was done via the PubMed, EMBASE, and ISI Web of Knowledge databases from 1960 to 2012. Quality of the articles was assessed using the Downs and Black tool. RESULTS On the basis of the used key words, 100 articles were found, of which 20 articles were selected in accordance with the selection criteria. The scores of reporting, external validity, internal validity (bias), and internal validity (confounding) varied between 4-9, 1-3, 3-5, and 2-6, respectively. CONCLUSIONS The literature review confirmed that standing stability of amputees depends on level of amputation, type of amputation, and cause of amputation. Moreover, prosthetic characteristics such as prosthetic ankle stiffness have influences on dynamic stability, whereas torsional adaptor does not have any positive influence on stability during level walking and on turning stability. Therefore, it can be concluded that the stability of a person with amputation can be improved by the use of appropriate prosthesis components.
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Jayakaran P, Johnson GM, Sullivan SJ. Concurrent validity of the Sensory Organization Test measures in unilateral transtibial amputees. Prosthet Orthot Int 2013; 37:65-9. [PMID: 22760518 DOI: 10.1177/0309364612448391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM The physical asymmetries associated with a prosthesis raises the question of validity of the Sensory Organization Test (SOT) measures (equilibrium score (ES) and strategy score (SS)) in lower limb amputees. This study explores the validity of these measures in transtibial amputees by correlating with their corresponding centre of pressure (COP) excursion/velocity measures. TECHNIQUE Fifteen transtibial amputees (69.5 ± 6.5 years) completed three trials for each of the six SOT conditions. DISCUSSION The Spearman's rank correlation coefficients between ESs and global COP excursion/velocity measures ranged from 0.52 to 0.71 for Conditions 1, 4 and 5, 0.79 to 0.85 for Conditions 2 and 3, and 0.39 to 0.43 for Condition 6. The coefficients for SSs ranged between 0.78 and 0.97 for Conditions 1 to 5 and 0.55 to 0.67 for Condition 6. The corresponding sound and prosthetic side COP variables demonstrated varying strengths of association with ES and SS. Clinical relevance Of the two clinical measures examined, the SSs are strongly reflective of COP excursion/velocity measures and these findings have application in the interpretation of SOT when evaluating balance in transtibial amputees.
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Affiliation(s)
- Prasath Jayakaran
- Centre for Physiotherapy Research, University of Otago, Dunedin, New Zealand
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