Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis

Kim, Janis; Major, Matthew J.; Hafner, Brian J.; Sawers, Andrew

doi:10.1016/j.pmrj.2018.08.385

Cited by 57 publications

(81 citation statements)

References 70 publications

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“…Inadequate weight shift (reaching, turning, and transfers) 8 was the most frequent fall pattern category, and contrary to Kim et al, where slips and trips were found to be significantly more common among people with primarily traumatic LLA 8 . Among community dwelling older adults, existing evidence supports balance‐challenging exercises to prevent falls 59 .…”

Section: Discussionmentioning

confidence: 90%

“…All falls were classified using the Fall‐Type Classification Framework (Table 1). 8 The framework was developed from biomechanical theory, classifying falls by the location and source of the destabilizing force, and the resulting fall pattern. Three tiers of fall classification in this framework describe (1) falls according to the location of the destabilizing force: “Base of Support” (BOS), “Center of Mass” (COM), or “Other”; (2) falls according to the source of the destabilizing force: “Intrinsic” or “Extrinsic”; and (3) fall pattern (Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Anderson¹,

Miller

Murray

et al. 2020

PM&R

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Introduction Over half of all people with lower limb amputation (LLA) experience at least one fall annually. Furthermore, the majority of LLAs result from dysvascular health complications, contributing to balance deficits. However, fall‐related research specific to dysvascular LLA remains limited. Objective To characterize falls among adults with dysvascular LLA, using an existing Fall‐Type Classification Framework and to describe the functional characteristics of participants across the framework categories. Design Secondary data analysis from two randomized controlled trials. Setting Outpatient setting. Participants People (n = 69) 6 months to 5 years from dysvascular lower extremity amputation, who were ≥50 years of age and independently ambulatory using a prosthesis. Intervention None. Outcome Descriptions of self‐reported falls were collected on a weekly basis for 12 weeks, and analyzed using an existing Fall‐Type Classification Framework. Fall frequencies, estimated count, and estimated proportions were compared across all framework categories, with 95% confidence intervals. Functional measures (Timed Up and Go, Two Minute Walk, Five Meter Walk, and average step count) were collected, and averages for each participant who experienced a fall were calculated. Results Thirty participants (43.5%) reported 42 falls within 12 weeks. A variety of fall types were described. Incidence of falls was highest for intrinsic destabilization sources, from incorrect weight shift patterns during transfer activities. Conclusion Patients with dysvascular LLAs experience a variety of fall types. The high frequency of intrinsically sourced, incorrect weight‐shift falls during transfer activities emphasizes the need to focus rehabilitation efforts on improving postural control in patients with dysvascular LLAs during activities such as reaching, turning, and transferring.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Anderson¹,

Miller

Murray

et al. 2020

PM&R

View full text Add to dashboard Cite

show abstract

“…Furthermore, the tested sample of community-dwelling BKPUs demonstrated high levels of baseline balance function, and the results are therefore limited by the representativeness of cohort. However, fall risk is relevant for prosthesis users at all stages in the rehabilitation journey [ 13 ], including community-dwelling individuals, and so these findings remain relevant to the body of work on this topic. Finally, the result should be interpreted knowing that there is potential for a learning effect given the repeated exposure of perturbations.…”

Section: Discussionmentioning

confidence: 99%

“…For BKPUs the consequences of lower limb loss, including a reduced ability to sense body dynamics [ 6 , 7 ] and to generate active joint control [ 8 – 11 ], contribute to the challenge of controlling frontal-plane locomotor stability. Considering that approximately 50% of community-living individuals with lower limb loss will fall at least once per year [ 12 ] and that the majority of these falls are initiated by intrinsic factors (i.e., those attributable to the person) [ 13 ] it is important that we understand the issues influencing the capacity of BKPUs to maintain frontal-plane locomotor stability.…”

Section: Introductionmentioning

confidence: 99%

Perturbation recovery during walking is impacted by knowledge of perturbation timing in below-knee prosthesis users and non-impaired participants

2020

Self Cite

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Previous research found that below-knee prosthesis users proactively increase their lateral margin-of-stability on their impaired side in anticipation of an impending perturbation when the timing is predictable and potentially directed toward the impaired limb. While knowledge of perturbation timing and direction influences proactive strategies, the consequences of such knowledge and anticipatory behavior on recovery from perturbations is unclear. This study characterized center-of-mass (CoM) dynamics of below-knee prosthesis users and non-impaired controls following a lateral perturbation when the perturbation direction is known but a priori knowledge of the timing of perturbation is either known or unknown. Across groups, CoM displacement during perturbation exposure increased when directed towards the impaired or non-dominant limb with no influence of timing knowledge. In addition, peak CoM displacement was less with known timing irrespective of the perturbation direction. Generally, the CoM displacement during perturbation exposure correlated well with the CoM medial-lateral velocity during unperturbed walking, supporting evidence that human response dynamics to lateral perturbations are influenced by the instantaneous state of the body’s momentum.

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“…Lower limb amputation has a substantial effect on an individual's functional ability, [1][2][3][4] as evidenced by the 26%-62% of lower limb prosthesis users who regain the ability to walk outdoors. 1 Among the functional challenges faced by lower limb prosthesis users, increased metabolic demand, [5][6][7] decreased balance ability, [8][9][10][11][12] decreased walking speed, 13,14 increased stumbles and falls, 12,[15][16][17] reduced activity level, 18,19 and difficulty ambulating on hills, stairs, or uneven terrain [20][21][22] are frequently cited. A wide variety of prosthetic interventions are available and have been used with varying degrees of success, [23][24][25][26][27][28][29][30][31][32] to address these balance, mobility, and endurance challenges.…”

Section: Introductionmentioning

confidence: 99%

Strength deficits in lower limb prosthesis users

Hewson

Dent

Sawers

2020

Prosthetics &Amp; Orthotics International

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Background: Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs. Objectives: Synthesize reported strength deficits in lower limb prosthesis users, and discuss possible causes, consequences, and solutions. Study Design: Scoping review. Methods: A search of biomedical databases was performed, and inclusion/exclusion criteria were applied to identify publications relevant to the purpose of the review. Results: In all, 377 publications were identified, of which 12 met the inclusion/exclusion criteria. When compared with the controls and the intact limb, the primary strength outcome, peak torque, was lower in transtibial residual limb knee flexors and extensors, as well as transfemoral residual limb hip muscles. Conclusions: The reviewed studies provide evidence of strength deficits in lower limb prosthesis users. These deficits appear to be consequential, as they may contribute to balance, mobility, and endurance impairments. Additional research exploring alternative strength metrics, clinical tests, and causal links to functional impairments is required. Clinical relevance Evidence of muscle weakness among lower limb prosthesis users, and its influence on balance, mobility, and endurance, suggests that greater clinical attention and scientific inquiry into physical conditioning of lower limb prosthesis users is merited and required.

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Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis

Abstract: III.

Cited by 57 publications

References 70 publications

Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Falls After Dysvascular Transtibial Amputation: A Secondary Analysis of Falling Characteristics and Reduced Physical Performance

Perturbation recovery during walking is impacted by knowledge of perturbation timing in below-knee prosthesis users and non-impaired participants

Strength deficits in lower limb prosthesis users

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