Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses

Abstract

Background Transfemoral prosthesis users’ high fall rate is related to increased injury risk, medical costs, and fear of falling. Better understanding how stumble conditions (e.g., participant age, prosthesis type, side tripped, and swing phase of perturbation) affect transfemoral prosthesis users could provide insight into response deficiencies and inform fall prevention interventions. Methods Six unilateral transfemoral prosthesis users experienced obstacle perturbations to their sound limb in early, mid, and late swing phase. Fall outcome, recovery strategy, and kinematics of each response were recorded to characterize (1) recoveries versus falls for transfemoral prosthesis users and (2) prosthesis user recoveries versus healthy adult recoveries. Results Out of 26 stumbles, 15 resulted in falls with five of six transfemoral prosthesis users falling at least once. By contrast, in a previously published study of seven healthy adults comprising 214 stumbles using the same experimental apparatus, no participants fell. The two oldest prosthesis users fell after every stumble, stumbles in mid swing resulted in the most falls, and prosthesis type was not related to strategy/fall outcomes. Prosthesis users who recovered used the elevating strategy in early swing, lowering strategy in late swing, and elevating or lowering/delayed lowering with hopping in mid swing, but exhibited increased contralateral (prosthetic-side) thigh abduction and trunk flexion relative to healthy controls. Falls occurred if the tripped (sound) limb did not reach ample thigh/knee flexion to sufficiently clear the obstacle in the elevating step, or if the prosthetic limb did not facilitate a successful step response after the initial sound-side elevating or lowering step. Such responses generally led to smaller step lengths, less anterior foot positioning, and more forward trunk flexion/flexion velocity in the resulting foot-strikes. Conclusions Introducing training (e.g., muscle strength or task-specific motor skill) and/or modifying assistive devices (e.g., lower-limb prostheses or exoskeletons) may improve responses for transfemoral prosthesis users. Specifically, training or exoskeleton assistance could help facilitate sufficient thigh/knee flexion for elevating; training or prosthesis assistance could provide support-limb counteracting torques to aid in elevating; and training or prosthesis assistance could help initiate and safely complete prosthetic swing.

Efficacy of stumble recovery assistance in a knee exoskeleton for individuals with simulated mobility impairment: A pilot study

“…Furthermore, thigh range of motion and thigh velocity range also increased for 8/10 and 10/10 pairs, respectively. Thus this dedicated stumble recovery assistance at the knee not only improved knee motion but also facilitated a better thigh response, both of which are key components of the elevating step (Grabiner et al, 1993 ; Eveld et al, 2022 ).…”

Bio-Inspired Auto-Adaptive Framework for Optimized Movement of Passive Knee Prosthesis

“…Understanding their stumble conditions to prevent falls in transfemoral amputees is also helpful. It may be possible to improve recovery by strengthening muscles, improving motor skills, or using assistive devices 38 . Olesnavage et al developed a framework quantifying the relationship between biomechanical performance and prosthetic foot geometry.…”

Automatic Stub Avoidance for a Powered Prosthetic Leg Over Stairs and Obstacles

“…However, these devices require significant compensations (e.g., hip hiking, hip circumduction, and/or vaulting) from the user to achieve foot clearance [1]. The lack of precise control and proprioception contributes to a high rate of stumbles, trips, and falls for transfemoral prosthesis users [2]- [4]. Passive devices also cannot provide the positive mechanical work needed for activities such as ramp ascent and stair ascent (SA), which are only possible with additional compensations from intact joints [5], [6].…”