Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Petersen, Bailey; Sparto, P.J.; Fisher, LE.

doi:10.1016/j.gaitpost.2022.10.018

Cited by 7 publications

(5 citation statements)

References 41 publications

(44 reference statements)

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“…In this study, the trunk flexion and extension angle in the Late-swing under the hyperopic 450° condition was larger than normal, at same time, the hip inversion and abduction angle was significantly larger than normal, and this phenomenon may be due to the fact that the hip and trunk are adjacent to each other, and the increase in trunk flexion and extension angle may be related to the hip angle and the proportion of each phase in the gait cycle, and it is mainly the rectus femoris muscle in the Late-swing that makes the lower leg swing forward and maintains the stability of the lower leg in the Late-swing, and it is also one of the main force-generating muscles in hip flexion ( Xiong et al, 2022 ). Thus, it was confirmed that trunk postural control and hip joint movement angle are closely related and that the transmission, analysis and integration of sensory information related to trunk control is reduced in participants, which affects trunk control ( Petersen et al, 2022 ). Therefore, this study suggests that people with hyperopia should strengthen the training of core muscles to increase the postural control of the body in order to reduce the probability of falling.…”

Section: Discussionmentioning

confidence: 87%

Effects of various hyperopia intervention levels on male college students’ gait kinematics

Zeng¹,

Xue²,

Zha³

et al. 2023

Front. Physiol.

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Background: Hyperopia is a common blurred vision phenomenon that affects postural control in gait; however, current research has focused on the alteration and correction of hyperopia’s physiological characteristics, ignoring the effect of hyperopia on gait kinematic characteristics. The effect of hyperopia on the basic form of movement walking is a worthy concern.Objective: To investigate the gait kinematic characteristics of male college students with varying degrees of visual acuity (normal vision, hyperopia 150°, and hyperopia 450°), as well as to provide a theoretical foundation for the effect of visual acuity on gait and fall risk reduction.Methods: Twenty-two male college students with normal visual acuity were chosen. Their vision was tested using a standard visual acuity logarithm table at normal and with 150° and 450° concave lenses. Gait kinematic data were collected under normal vision and hyperopic conditions using the PN3 Pro advanced inertial motion capture system and Axis Studio application program.Results and conclusion: 1. The change of center of gravity in Pre-double support was smaller than normal vision; Late-single support and Late-swing was larger than normal vision; 2. The percentage of the double-leg support decreased; the percentage of the single-leg support and the Late-swing increased; 3. For the joints’ range of motion, Trunk flexion and extension range of motion in Pre-single support, Late-double support and Pre-swing smaller than normal visual acuity, and Late-swing larger than normal; hip internal abduction and adduction and internal and external rotation are larger than normal vision in Late-single support; knee and ankle in abduction and adduction direction are larger than normal vision in the swing stage; hip flexion and extension, internal external rotation are larger than normal vision in the swing stage. Hyperopic interventions have an impact on the kinematic characteristics of gait in male college students, mainly in terms of altered balance, increased instability, increased difficulty in maintaining trunk stability, and increased risk of injury.

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Section: Discussionmentioning

confidence: 87%

Effects of various hyperopia intervention levels on male college students’ gait kinematics

Zeng¹,

Xue²,

Zha³

et al. 2023

Front. Physiol.

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“…18 Previous research exploring the relationship between sensation and clinical outcome measures in individuals with amputation found no difference across 2 groups differentiated by light touch perception threshold. 19 It seems likely that the interface between the limb and prosthesis may add complexity to the relationship between perceptual ability from a neurological perspective and functional performance. Despite similar vibration perceptual thresholds at the tibial tuberosity across limbs, the perception of platform vibration was poorer on average on the prosthetic side compared to the intact side in partial loading, further supporting an important role of the prosthesis and its interface in the detection of external stimuli.…”

Section: Discussionmentioning

confidence: 99%

Socket-residuum coupling integrity affects perception of external stimuli: Effects of altering the transtibial interface using vacuum-assisted suspension

Kent

Carnahan

Major

2023

Prosthetics &Amp; Orthotics International

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Background: Relative movement between the socket and residual limb can impair function in prosthesis users. It is plausible that, in addition to its mechanical effect, the integrity of the socket-residuum interface influences the ability of an individual to sense tactile cues through the prosthesis. Vacuum-assisted suspension (VAS) has been shown to reduce relative movement at this interface, providing a means to test this premise. The purpose of this pilot study was to assess the effects of altering socket-residuum interface integrity through the VAS pressure level on the thresholds of perception of an externally applied vibration stimulus. Methods: Seven unilateral transtibial prosthesis users participated. Socket-residual limb integrity was altered using the VAS subatmospheric (vacuum) pressure level. Vibration perception tests were conducted at low, mid, and high vacuum levels, targeting 0, 8, and 19 in Hg respectively, and performed in partially loaded and fully loaded conditions. Vibration intensity was increased using a dial until participants delivered a verbal signal indicating it was perceptible, and the nominal intensity was recorded. Results: Intensity thresholds decreased (ie, sensitivity increased) from low to high vacuum settings when fully loaded (P = 0.008). Differences when partially loaded were nonsignificant and variable across participants. Conclusion: This study provides preliminary evidence that altering the integrity between the socket and residual limb by modifying the vacuum level affects sensation related to the external environment experienced through the prosthesis, although translation of these findings to real-world stimuli remains to be tested.

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“…However, the PAT presented a wide spread in the scores obtained by impaired participants, reflecting the ample range of performance, where high-performing impaired participants could be distinguished from other impaired participants. The ability to distinguish levels of impairment within participants has been pointed out as a limitation of standard clinical measures 10 . Our approach with the PAT was to deliver a tool that would allow following the progress of users of any level of performance (from very low to high).…”

Section: Discussionmentioning

confidence: 99%

“…Functionally relevant clinical tests for assessing balance proficiency fall into one of three categories: timed tests, reaching tests, and stepping tests; these require the patient to perform an activity that involves sitting, standing, or stepping 8 . However, clinical balance assessment tools may show ceiling effects or insensitivity to incremental progress or deterioration in a patient's ability to balance 7 , 9 or be unable to differentiate between levels of impairment within a given population 10 . Moreover, these tools focus on measuring a degree of balance proficiency that allows a patient to be discharged from rehabilitation or go back to typical daily life activities.…”

Section: Introductionmentioning

confidence: 99%

Technology-based balance performance assessment can eliminate floor and ceiling effects

Forero,

Vette,

Hebert

2023

Sci Rep

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Many clinical measurement tools for balance have ceiling effects. Technology-based assessments using virtual reality systems such as the Computer-Assisted Rehabilitation Environment (CAREN) may provide a way to develop objective, quantitative measures that scale from low to high levels of difficulty. Our objective was to: (1) develop a performance assessment tool (PAT) for the CAREN; (2) quantify the reliability of the tool; (3) validate the scores against clinical balance measures; and (4) compare the scores from a population with balance impairments to those from able-bodied individuals in a cross-sectional validation study. Three games were developed on the CAREN and tested on 49 participants (36 able-bodied and 13 with impaired mobility). For each module, the corresponding measures were transformed into scores using a series of functions such that ceiling and flooring effects would be minimized. The results showed an association between scores and age, an overlap in scores from impaired high-performance individuals and able-bodied low performance individuals, and a correlation of PAT scores with other clinical tests. Several of the limitations of current clinical tools, including floor and ceiling effects, were overcome by the PAT, suggesting that the PAT can be used to monitor the effect of rehabilitation and training.

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Clinical measures of balance and gait cannot differentiate somatosensory impairments in people with lower-limb amputation

Cited by 7 publications

References 41 publications

Effects of various hyperopia intervention levels on male college students’ gait kinematics

Effects of various hyperopia intervention levels on male college students’ gait kinematics

Socket-residuum coupling integrity affects perception of external stimuli: Effects of altering the transtibial interface using vacuum-assisted suspension

Technology-based balance performance assessment can eliminate floor and ceiling effects

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